Warren County Ohio Separation Agreement

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Warren County Ohio Separation Agreement Powered By Docstoc
					                           Warren County Board of DD
                              Agency Procedures
                               Alphabetical Order

AGP   4.01   Accounts Payable
AGP   4.02   Accounts Receivable Requirements
AGP   1.20   Acuity Assessment
AGP   1.18   Adult Day Waiver Services Request for Administrative Review
AGP   2.09   Agency Assistance of Administrative Resolution of Complaint Process
AGP   3.01   Agency Eligibility
AGP   2.05   Agency Incident Reviews
AGP   1.07   Agency Volunteer Application Process
AGP   4.25   Alcohol and Drug Free Workplace
AGP   2.06   Analysis Review of Major Unusual Incidents and Unusual Incidents
AGP   4.06   Annual Abuser Registry Notice
AGP   4.28   Applicant Hiring
AGP   4.26   Applicant Recruitment
AGP   4.27   Applicant Selection
AGP   4.11   Appropriate Interaction Guidelines
AGP   1.08   Authorization for Use-Disclosure of Information (HIPAA)
AGP   3.05   Behavior Supports
AGP   3.06   Behavior Supports Referrals
AGP   2.15   Building Safety
AGP   4.20   Certification of ODODD
AGP   1.00   Community Alternative Funding System (CAFS)
AGP   2.08   Complaint Process
AGP   4.29   Criminal Background Check
AGP   4.03   Data Processing
AGP   3.03   Death of Enrolled Individual
AGP   2.40   Deerfield Emergency Evacuation
AGP   2.39   Deerfield Violent or Threatening Situation
AGP   1.01   Documentation of Services
AGP   2.21   Emergency Drills
AGP   2.19   Employee Incident and Injury
AGP   4.30   Employee Performance Evaluation
AGP   4.31   Employee Separation
AGP   3.02   Exit from Agency
AGP   4.12   Extended Illness Leave
AGP   1.25   Financial Oversight Committee
AGP   4.13   FMLA
AGP   4.14   Health Insurance
AGP   2.00   Incidents Adversely Affecting Health and Safety
AG{   1.22   Inclement Weather/Calamity Day
AGP   1.02   Individual and Fiscal Records
AGP   1.19   Individual Information Form (IIF)
AGP   1.09   Individual Request for an Accounting of Disclosures (HIPAA)
AGP   1.11   Individual Request for Confidential Communications (HIPAA)
AGP   1.12   Individual Request for Extra Restrictions Regarding Use & Disclosure (HIPAA)
AGP   4.04   Infallible Updates
AGP   2.17   Infection Control
AGP   4.15   In-service Training
AGP   4.05   Inventory Control



                                          Page 1 of 3
                           Warren County Board of DD
                              Agency Procedures
                               Alphabetical Order

AGP   2.02   Investigating Major Unusual Incidents
AGP   4.22   Job Description
AGP   4.21   Legal Assistance in Personnel
AGP   1.16   Medicaid Administrative Claiming
AGP   2.12   Medical Emergencies
AGP   2.20   Medical Emergencies on Transportation
AGP   2.37   MHBC Emergency Evacuation
AGP   2.38   MHBC Violent or Threatening Situations
AGP   1.10   Minimum Necessary Use and Disclosure (HIPAA)
AGP   2.04   MUI Recommendation Follow-up Reports
AGP   2.03   MUI-UI Investigation Involving WCBDD Employee and Other Specified Individuals
AGP   1.15   Notice of Privacy (HIPAA)
AGP   3.04   Outcomes Measurement System
AGP   4.10   Paycheck Pickup
AGP   1.17   Payment Authorizatin for Waiver Services (PAWS)
AGP   4.16   Personnel Files
AGP   2.16   Post-Exposure Evaluation and Follow-up
AGP   4.23   Procedure for Prior Service Credit
AGP   3.07   Procedures for completing Behavior Support Documentation
AGP   2.13   Program Placement - Safety
AGP   2.33   PSU Bomb Threat
AGP   2.34   PSU Earthquake Emergency
AGP   2.30   PSU Fire Evacuation-Fire Drill
AGP   2.32   PSU Power Failure
AGP   2.31   PSU Tornado Drill
AGP   2.35   PSU Toxic Spill
AGP   2.36   PSU Violent or Threatening Situation
AGP   4.00   Purchase Order Submission
AGP   2.07   Quality Assurance Reviews
AGP   4.17   Records Management
AGP   2.10   Safe Environment
AGP   2.11   Safe Working Environment
AGP   1.14   Safeguarding Information (HIPAA)
AGP   2.14   Safety Committee
AGP   2.18   Seizure Response and Reporting
AGP   4.24   Staff Training
AGP   3.00   Third Party Insurance
AGP   4.09   Timesheets
AGP   1.04   Title XX Application for Eligibility-Redetermination
AGP   1.05   Title XX Documentation
AGP   1.03   Title XX Federal Assistance Program
AGP   1.06   Title XX Reimbursement Summary Report
AGP   4.18   Transfer, Promotion, Demotion
AGP   1.23   Transition Plan for those Receiving Alternative Services
AGP   1.24   Transportation Subsidy for Services in Excess of Budget
AGP   4.08   Tuition Reimbursement
AGP   2.01   Unusual Incidents Definition and Reporting
AGP   1.13   Verification of Identity and Authority of Entities Requesting PHI (HIPAA)



                                         Page 2 of 3
                           Warren County Board of DD
                              Agency Procedures
                               Alphabetical Order

AGP   4.07   Waiver of Insurance
AGP   1.21   Waiver Service
AGP   2.25   WCYC Bomb Threat
AGP   2.26   WCYC Earthquake Emergency
AGP   2.28   WCYC Emergency Shutoff
AGP   2.22   WCYC Fire Evacuation - Fire Drills
AGP   2.24   WCYC Power Failure
AGP   2.23   WCYC Tornado Emergency
AGP   2.27   WCYC Toxic Spill
AGP   2.29   WCYC Violent or Threatening Situations
AGP   4.19   Worker's Compensation




                                         Page 3 of 3
                           Warren County Board of DD
                              Agency Procedures
                                Numeric Order

AGP   1.00   Community Alternative Funding System (CAFS)
AGP   1.01   Documentation of Services
AGP   1.02   Individual and Fiscal Records
AGP   1.03   Title XX Federal Assistance Program
AGP   1.04   Title XX Application for Eligibility-Redetermination
AGP   1.05   Title XX Documentation
AGP   1.06   Title XX Reimbursement Summary Report
AGP   1.07   Agency Volunteer Application Process
AGP   1.08   Authorization for Use-Disclosure of Information (HIPAA)
AGP   1.09   Individual Request for an Accounting of Disclosures (HIPAA)
AGP   1.10   Minimum Necessary Use and Disclosure (HIPAA)
AGP   1.11   Individual Request for Confidential Communications (HIPAA)
AGP   1.12   Individual Request for Extra Restrictions Regarding Use & Disclosure (HIPAA)
AGP   1.13   Verification of Identity and Authority of Entities Requesting PHI (HIPAA)
AGP   1.14   Safeguarding Information (HIPAA)
AGP   1.15   Notice of Privacy (HIPAA)
AGP   1.16   Medicaid Administrative Claiming
AGP   1.17   Payment Authorizatin for Waiver Services (PAWS)
AGP   1.18   Adult Day Waiver Services Request for Administrative Review
AGP   1.19   Individual Information Form (IIF)
AGP   1.20   Acuity Assessment
AGP   1.21   Waiver Service
AGP   1.22   Inclement Weather/Calamity Day
AGP   1.23   Transition Plan for those Receiving Alternative Services
AGP   1.24   Transportation Subsidy for Services in Excess of Budget
AGP   1.25   Financial Oversight Committee
AGP   2.00   Incidents Adversely Affecting Health and Safety
AGP   2.01   Unusual Incidents Definition and Reporting
AGP   2.02   Investigating Major Unusual Incidents
AGP   2.03   MUI-UI Investigation Involving WCBDD Employee and Other Specified Individuals
AGP   2.04   MUI Recommendation Follow-up Reports
AGP   2.05   Agency Incident Reviews
AGP   2.06   Analysis Review of Major Unusual Incidents and Unusual Incidents
AGP   2.07   Quality Assurance Reviews
AGP   2.08   Complaint Process
AGP   2.09   Agency Assistance of Administrative Resolution of Complaint Process
AGP   2.10   Safe Environment
AGP   2.11   Safe Working Environment
AGP   2.12   Medical Emergencies
AGP   2.13   Program Placement - Safety
AGP   2.14   Safety Committee
AGP   2.15   Building Safety
AGP   2.16   Post-Exposure Evaluation and Follow-up
AGP   2.17   Infection Control
AGP   2.18   Seizure Response and Reporting
AGP   2.19   Employee Incident and Injury
AGP   2.20   Medical Emergencies on Transportation
AGP   2.21   Emergency Drills



                                         Page 1 of 3
                           Warren County Board of DD
                              Agency Procedures
                                Numeric Order

AGP   2.22   WCYC Fire Evacuation - Fire Drills
AGP   2.23   WCYC Tornado Emergency
AGP   2.24   WCYC Power Failure
AGP   2.25   WCYC Bomb Threat
AGP   2.26   WCYC Earthquake Emergency
AGP   2.27   WCYC Toxic Spill
AGP   2.28   WCYC Emergency Shutoff
AGP   2.29   WCYC Violent or Threatening Situations
AGP   2.30   PSU Fire Evacuation-Fire Drill
AGP   2.31   PSU Tornado Drill
AGP   2.32   PSU Power Failure
AGP   2.33   PSU Bomb Threat
AGP   2.34   PSU Earthquake Emergency
AGP   2.35   PSU Toxic Spill
AGP   2.36   PSU Violent or Threatening Situation
AGP   2.37   MHBC Emergency Evacuation
AGP   2.38   MHBC Violent or Threatening Situations
AGP   2.39   Deerfield Violent or Threatening Situation
AGP   2.40   Deerfield Emergency Evacuation
AGP   3.00   Third Party Insurance
AGP   3.01   Agency Eligibility
AGP   3.02   Exit from Agency
AGP   3.03   Death of Enrolled Individual
AGP   3.04   Outcomes Measurement System
AGP   3.05   Behavior Supports
AGP   3.06   Behavior Supports Referrals
AGP   3.07   Procedures for completing Behavior Support Documentation
AGP   4.00   Purchase Order Submission
AGP   4.01   Accounts Payable
AGP   4.02   Accounts Receivable Requirements
AGP   4.03   Data Processing
AGP   4.04   Infallible Updates
AGP   4.05   Inventory Control
AGP   4.06   Annual Abuser Registry Notice
AGP   4.07   Waiver of Insurance
AGP   4.08   Tuition Reimbursement
AGP   4.09   Timesheets
AGP   4.10   Paycheck Pickup
AGP   4.11   Appropriate Interaction Guidelines
AGP   4.12   Extended Illness Leave
AGP   4.13   FMLA
AGP   4.14   Health Insurance
AGP   4.15   In-service Training
AGP   4.16   Personnel Files
AGP   4.17   Records Management
AGP   4.18   Transfer, Promotion, Demotion
AGP   4.19   Worker's Compensation
AGP   4.20   Certification of ODODD



                                         Page 2 of 3
                           Warren County Board of DD
                              Agency Procedures
                                Numeric Order

AGP   4.21   Legal Assistance in Personnel
AGP   4.22   Job Description
AGP   4.23   Procedure for Prior Service Credit
AGP   4.24   Staff Training
AGP   4.25   Alcohol and Drug Free Workplace
AGP   4.26   Applicant Recruitment
AGP   4.27   Applicant Selection
AGP   4.28   Applicant Hiring
AGP   4.29   Criminal Background Check
AGP   4.30   Employee Performance Evaluation
AGP   4.31   Employee Separation




                                          Page 3 of 3
                                                                                               Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

COMMUNITY ALTERNATIVE FUNDING SYSTEM (CAFS)                                              SECTION 1.00



PURPOSE:         WCBDD will comply with the ODODD Chapter 119 Administrative Rule 5123:2-15 and
the rule subsets of:

5123:2-15-01           Habilitation center services agency certification
5123:2-15-04           Provider agreements
5123:2-15-07           Eligibility
5123:2-15-10           Reimbursements
5123:2-15-11           Operational fees for CAFS services
5123:2-15-14           Skills development and supports components of CAFS
5123:2-15-16           Contracts between ICF’s/DD and certified habilitation centers
5123:2-15-18           Components of an individual plan process and individual plan
5123:2-15-19           Counseling and social work services through CAFS
5123:2-15-21           Nursing services in county boards through CAFS
5123:2-15-22           Nursing services in an agency other than a county board through CAFS
5123:2-15-23           Nutrition services through CAFS
5123:2-15-25           Occupation therapy services through CAFS
5123:2-15-28           Physical therapy services through CAFS
5123:2-15-31           Physician services through CAFS
5123:2-15-34           Psychology services through CAFS
5123:2-15-37           Speech therapy and audiology services through CAFS
5123:2-15-40           Transportation services
5123:2-15-41           Service coordinator services for agencies through CAFS

A. INTENT TO PARTICIPATE

   1. It is the intent of the Warren County Board of Developmental Disabilities to maintain certification
      as a Habilitation Center Services Provider to obtain Community Alternative Funding system
      (CAFS) funding in the following areas:

       a.   Active Treatment
       b.   Skills Development and Supports
       c.   Professional Services
       d.   Targeted Case Management/Service Coordination
       e.   Transportation

B. The administration shall submit and maintain a provider agreement with the Department of Human
   Services for the CAFS covered services the agency is qualified to provide and for which
   reimbursement will be claimed.

   It is the intent of the Warren County Board of Developmental Disabilities to utilize the ODODD CAFS
   provider manual as their procedural guidelines.

C. CERTIFICATION REQUIREMENTS:

   1. The administration shall develop written policies and/or procedures and provide the covered
      services in compliance with Department of Developmental Disabilities under section 5123:2-15 of
      the Ohio Administrative Code that govern the Community Alternative Funding System, including:


                              Community Alternative Funding System (CAFS)
                                              Page 1 of 6
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       a. Eligibility determination
       b. Due process/resolution of complaints
       c. Method of sharing policies/procedures regarding due process and confidentiality with
          individuals/parents/guardians
       d. Individual plan development
       e. Documentation of services
       f. Individual record and fiscal information, to include
       g. Confidentiality, access, duplication, dissemination, destruction
       h. Collection/maintenance of records to support billing/cost reporting
       i. Record retention
       j. Designation of agency in the service recipient’s IP as a service provider
       k. Assessment/evaluation, crisis intervention services
       l. Maintenance of the current individual plan/individual service plan on file to support services
          reimbursed through CAFS
       m. Documentation of transportation services

D. ELIGIBILITY

   1. The Warren County Board of Developmental Disabilities agrees to provide covered services to all
      recipients, both Medicaid and non-Medicaid, regardless of the county of origin or residence,
      unless there is statutory authority, which limits enrollment. Where capacity limits enrollment in a
      Board program or facility, a waiting list will be maintained.

   2. In order to be certified by ODDD and receive reimbursement, the WCBDD must serve individuals
      who are “eligible.” CAFS administrative rule 5123:2-15-07 (Eligibility Requirements) specifically
      addresses the eligibility requirements for those individuals who receive services through a
      habilitation center and for whom the habilitation center may seek reimbursement through CAFS
      for the costs associated with the provision of those services.

   3. An agency is eligible to receive reimbursement for services to individuals who are Medicaid
      eligible and who have a developmental disability, developmental delay, or who are at risk for
      developmental delay. Children who are Medicaid eligible and are determined by the local
      educational agency (LEA) as having a certified need are included in the eligibility pool.

       ELIGIBILITY REQUIREMENTS FOR ACTIVE TREATMENT COMPONENT:

           In order for the habilitation center to bill CAFS under this component, the individuals must:

               i.   Be Medicaid eligible and
               a.   Reside in a ICF/MR with whom the habilitation center has entered into a contract and
               b.   Receive coordinated services with a designated Board liaison to the QMRP and
               c.   Have a developmental disability, a developmental delay, or be at risk, and receive
                    services from a certified habilitation center other than the facility in which the
                    individual resides, unless the facility of residence is a governmental entity

       2. ELIGIBILITY REQUIREMENTS FOR SKILLS DEVELOPMENT AND SUPPORTS:

           In order for the habilitation center to bill CAFS under this component, the individual must:

               a. Be Medicaid eligible and
               b. Be enrolled in an ODDD Home and Community-Based Services (HCBS) Waiver and
               c. Receive services pursuant to the IP process

           The ODODD HCBS waivers enable the enrollee to live in the community with the provision of
           needed supports. Those supports are noted in a service plan that is individualized to meet



                              Community Alternative Funding System (CAFS)
                                              Page 2 of 6
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            the unique needs of the person. The certified habilitation center must be identified in the
            service plan as a provider of services for that individual.

        3. ELIGIBILITY REQUIREMENTS FOR PROFESSIONAL SERVICES:

            In order for the habilitation center to bill CAFS under this component, the individual must:

                a. Be Medicaid eligible and
                b. Have a developmental disability, a developmental delay, or be at risk, and receive
                   services from a certified habilitation center other than the facility in which the
                   individual resides, unless the facility of residence is a governmental entity or
                c. Be certified by the local educational agency (LEA) as having a need for professional
                   services, and receive services from a certified habilitation center other than the
                   facility in which the individual resides, unless the facility of residence is a
                   governmental entity.

            If the individual lives in a nursing facility (NF), the habilitation center may bill for PT, OT,
            speech-language pathology and audiology services, service coordinator and transportation.

            If the individual is enrolled in an ODODD HCBS waiver, the habilitation center will bill under
            the skills development and supports component. If the individual resides in an ICF/MR, the
            habilitation center will bill under the active treatment component.


        4. ELIGIBILITY REQUIREMENTS FOR TCM/SERVICE COORDINATION COMPONENT:

            In order for the habilitation center to bill CAFS under this component, the individual must:

            a. Be Medicaid eligible and
            b. Have a developmental disability, a developmental delay, or be at risk, and receive
               services from a certified habilitation center or
            c. Be certified by the local education agency (LEA) as having a need for case
               management/service coordination services, and either be in the eligibility determination
               process or receive services from a certified habilitation center and
            d. Need to receive services per the individual plan process written in accordance with rule
               5123:2-15-18 of the Administrative Code

            NOTE: An agency may bill service coordination services prior to plan development for an
            individual identified with a potential need for services.

        5. ELIGIBILITY REQUIREMENTS              FOR     BILLING    TRANSPORTATION           UNDER         ANY
           COMPONENT:

            Transportation services are billable when:

                a. Transportation is provided to eligible individuals who receive a minimum of one unit
                   that day of other CAFS services
                b. The individuals are transported to and/or from the habilitation center or other service
                   delivery site and
                c. The habilitation center incurs the cost of providing that service

E.      REIMBURSEMENT

     The WCBDD certified habilitation center may seek reimbursement through CAFS for covered
     services that are provided either directly or through contractual agreements, to individuals who:



                               Community Alternative Funding System (CAFS)
                                               Page 3 of 6
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            1.   Have a developmental disability (ies)
            2.   Have a developmental delay (s)
            3.   Are at risk (infants-children birth through 5 years of age) or
            4.   Have a certified need

     The WCBDD has become certified to seek reimbursement through the Community Alternative
     Funding System (CAFS) for services in the professional services component, the active treatment
     component, the skills development and supports component, the targeted case
     management/service coordinator component and the transportation component.

     The WCBDD is responsible for the verification and credentials of personnel providing services that
     the board intends to bill to CAFS. The board must ensure that the required current and valid
     relevant certification/licenses are on file. This can include a roster of service providers’ names, with
     their corresponding licenses and/or certification numbers and expiration dates.

F.     ELIGIBILITY AND SERVICES BILLABLE TO CAFS:

            1. Individuals who reside anywhere other than in Nursing Facilities (NFs) and ICFs/MR and
               who are not enrolled on an ODDD Home and Community Based Services (HCBS)
               Waiver

                 If the agency serves individuals who are Medicaid-eligible/have a certified need/or who
                 are “at risk” or who have a developmental disability, the habilitation center may be eligible
                 for reimbursement for the following services delivered by a professional:

                 a.    Social Work/Counseling services
                 b.    Nursing services
                 c.    Delegated Nursing services
                 d.    Nutrition services
                 e.    Occupational Therapy services
                 f.    Physical Therapy services
                 g.    Physician services
                 h.    Psychology services
                 i.    Speech-Language Pathology/Audiology services
                 j.    Transportation services
                 k.    Service Coordination services
                 l.    Targeted Case Management services

            b. Individuals Enrolled on an ODDD HCBS Waiver, the habilitation center may be eligible for
               reimbursement for the following services delivered by a professional or other direct
               service staff:

                         i.       Skills Development and Supports identified in IP
                         ii.      Transportation services
                         iii.     Service Coordination services
                         iv.      Targeted Case Management services

       c.   Individuals who reside in ICFs/MR

                 If the agency serves individuals who reside in Medicaid certified Intermediate Care
                 Facility for the Mentally Retarded (ICF/MR), the habilitation center may be eligible for
                 reimbursement for the following services, delivered by a professional or other direct serve
                 staff:

                 i.       Active Treatment
                 ii.      Transportation service

                                Community Alternative Funding System (CAFS)
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         iii.        Service Coordination services
         iv.         Targeted Case Management services

d. Individuals who reside in a Medicaid Certified Nursing Facility (NF)

         If the agency serves individuals who reside in a Medicaid certified NF, the habilitation
         center may be eligible for reimbursement for the following services when delivered by an
         appropriately licensed therapist:

                1.      Occupational Therapy services
                2.      Physical Therapy services
                3.      Speech-Language Pathology/Audiology services

         The agency may also bill for the following services when delivered by other designated
         staff:

                       i.      Transportation services
                       ii.     Service Coordination services
                       iii.    Targeted Case Management services

e. Income Schedule (Sliding Fee Schedule)

         It is the intent of the Warren County Board of Developmental Disabilities to follow and be
         in compliance with the Ohio Department of DD under Section 5123:2-1-09
          (Income Schedule) for co-payment of Medicaid related services as reimbursed to
         providers through participation in the Community Alternative Funding system. The
         percentage of co-payment for family or individual (if 18 years or older) will be determined
         according to the 5123:2-1-09 income schedule.

f.   Notification of Denial, Reduction, or Termination or Reimbursed Services

         The WCBDD will ensure that the Ohio Department of Human Services (ODHS) due
         process protections, that are to be offered to individuals, when CAFS reimbursed
         services are proposed to be denied, reduced or terminated by a certified habilitation
         center. Ohio Administrative Code (OAC) 5101:6-9 addresses hearing rights and appeal
         requirements, which apply to individuals receiving or requesting Medicaid covered
         services, including CAFS-reimbursed services provided by a certified habilitation center.
         Services that may be reimbursable through CAFS are to be based upon an assessed and
         medically related need for the service. The type, frequency and implementation of the
         needed service are to be reflected on the service recipient’s Individual Plan (IP). This
         plan development process allows for specific services to be identified and adjusted as
         needs fluctuate. Adverse actions to deny, reduce or terminate specific services may be
         the result of assessment outcomes, professional opinion, and/or service recipient
         request.

         When Medicaid-funded services are denied, reduced, or terminated the affected
         Medicaid-eligible individual has the right to a state hearing if she/he wishes to appeal the
         decision. This right to a state hearing regarding the adverse action is guaranteed in the
         federal statutes that govern all Medicaid-funded services. There are exceptions to the
         requirement for prior notice of proposed adverse action. (Please refer to rule 5101:6-2-
         05 of the Administrative Code).




                              Community Alternative Funding System (CAFS)
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APPROVED:


                                                                       March 26, 2010
      Megan K. Manuel, Superintendent                                      Date




                         Community Alternative Funding System (CAFS)
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                                                                                                Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

DOCUMENTATION OF SERVICES                                                                  SECTION 1.01



PURPOSE:         To ensure accurate and uniform documentation of services for CAFS billing.

PROCEDURE:

A.        DOCUMENTATION OF TRANSPORTATION SERVICES

     1.     All Transportation Services indicated in an individual’s IP/ISP shall be documented in the
            following manner:

            a. The WCBDD Documentation of Transportation Services Record shall be used to
               document services provided.

            b. Each day an individual boards a vehicle for transportation to/from services provided by
               the WCBDD (once in the morning and once in the afternoon), the driver will document it
               by placing a check (√) in the appropriate box.

            c.   The driver will sign/date the documentation sheet daily.

            d. This record will be turned into the division secretary weekly.

            e. The division secretary will turn this information into the business office by the end of the
                         nd
               second (2 ) working day of the following month.

B.        TARGETED CASE MANAGEMENT SERVICES:

     1.     All Targeted Case Management Services indicated in an individual’s IP/ISP shall be
            documented in the following manner:

            a. The Infallible Software System shall be utilized to document all Targeted Case
               Management Services.

            b. Services shall be documented as soon as possible after they are provided.

            c.   All documented case notes and services shall be printed out, signed, and initialed by the
                 service provider.

            d. The Targeted Case Management documentation shall be turned into their supervisor by
                                       nd
               the end of the second (2 ) working day of the agency of the following month.

            e. The documentation sheets should then be turned into the business office by the end of
               the fifth (5th) day of the agency of the following month.

C.        DOCUMENTATION OF DAY HAB:

     1.     Must meet all components of 5123: 2-9-05 for documentation requirements.

     2.     Document services as they occur on a daily basis.

     3.     Documentation sheets sent to WCBDD business services by the 15th of the month.

                                         Documentation of Services
                                              Page 1 of 2
                                                                           Effective 03/10




APPROVED:


                                                              March 26, 2010
      Megan K. Manuel, Superintendent                             Date




                                  Documentation of Services
                                       Page 2 of 2
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                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INDIVIDUAL AND FISCAL RECORDS                                                                 SECTION 1.02




PURPOSE: To ensure individual fiscal records are kept in accordance with the Ohio Administrative
Code.

PROCEDURE:

All TCM, Day Hab, and transportation related record information and fiscal data shall be maintained for a
period of seven (7) years from the date of receipt of payment or for six (6) years after any initiated audit is
completed and adjudicated, whichever is longer, and said records shall be available for any partial or full
review.



APPROVED:


                                                                                    March 26, 2010
          Megan K. Manuel, Superintendent                                               Date




                                         Individual and Fiscal Records
                                                  Page 1 of 1
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                    WARREN COUNTY BOARD DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

TITLE XX FEDERAL ASSISTANANCE PROGRAM                                                       SECTION 1.03



A. Intent to Participate

    It is the intent of the Warren County Board of Developmental Disabilities to participate in the Title XX
    federal assistance program through a contract/grant agreement with the Ohio Department
    Developmental Disabilities. The purpose is to maximize use of the federal assistance program to
    carry out the grant program objectives of employment services for mentally retarded and
    developmentally disabled residents in the community

B. Administration Requirements

    Administration of this contract shall include compliance in documentation and billing for grant funds.
    Services will be documented daily for each recipient showing the billing unit and number of units
    provided daily for the service of employment training. This log will be maintained locally as back up
    for the quarterly billing process. Billing will be completed according to required format and dates.

C. Eligibility

    Determination for eligibility for participation in the Title XX federal assistance program will coincide
    with eligibility for Warren County Board of Developmental Disabilities services through the OEDI
    process. These services will be provided to eligible individuals without regard to income and/or
    resources. Re-determination of eligibility will be completed at the annual program plan review for
    each participant. This process will include review of Board services and benefits for participation in
    employment training services according to the individual plan. By indicating on the Individual Plan the
    individual participates in the Title XX Federal Assistance Program, this also serves as notice of
    approval of the Title XX Application.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                    Title XX Federal Assistance Program
                                                Page 1 of 1
                                                                                                       Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

TITLE XX APPLICATION FOR ELIGIBILITY-REDERTERMINATION                                          SECTION 1.04



PURPOSE:        To develop a process for determining annual eligibility for Title XX recipients, which
allows the Board to bill for those services, specified under this program.

An individual is eligible to participant in the Title XX federal assistance program if he/she meets WCBDD
eligibility criteria.

PROCEDURE:

A.      The Application for Eligibility Determination-Re-Determination form should be completed by the
        Service Coordinator/designee for identified individuals at their Annual Self Directed Plan meeting.

B.      Directions for completion of the Application For Eligibility Determination-Re-Determination form is
        as follows:

            1. Section AA.                 Complete items 1-5

                          a.     Client Name: Last name, first name of the individual.
                          b.     Social Security Number
                          c.     Head of household: If the individual has a legally appointed guardian
                                 enter the guardian’s name.
                                 Individuals who are age 21 years and over and do not have a court
                                 assigned guardian are considered to be head of their own household,
                                 regardless of where they live. Enter “same”.
                          d.     Client Address: This is the individual’s current mailing address. Provide
                                 house number, street, city and zip.
                          e.     Social Security Number (Please Check for Accuracy).

            2. Section BB.

                          a.     Complete. Be sure this date is the same as GG.
                          b.     Check type of eligibility.
                          c.     Check “Initial” if it is the first application. Check “Re-determination” if this
                                 is a renewal of eligibility.

            3. Section CC.                 Prepared, do not change.

            4. Section DD.                 Prepared, do not change.

            5. Section EE.                 Prepared, do not change.

            6. Section FF.                 Prepared, do not change.

            7. Section GG.

C.      The individual should sign the applications and put the date (this date should match the date in
        BB a). If the individual cannot sign his/her name, have the person make his/her mark and sign as
        a witness (service coordinator/designee and job title). Submit completed form to the Business
        Office, Fiscal Specialist and a copy should be attached to individuals annual plan.


                               Title XX Application For Eligibility-Redetermination
                                                   Page 1 of 3
                                                                                                        Effective 03/10




D.      The date of application and signature dates will be that of the individuals plan meeting date. The
        individual plan will indicate that the person is Title XX Eligible. Eligibility and enrollment will be for
        the same service period as the individual plan. If an individual enrolls in the Title XX Program
        after the annual plan meeting occurs, an addendum will be added to the individual plan.

E.      DOCUMENTATION

            1. The Title XX Service Log agency form will be used in addition to individual’s payroll
               timesheets to document participation in the Title XX federal assistance program.


F.      Adult Service Providers/Community Service Providers should document daily on the Title XX Unit
        of Service Log the following information:

            1.   Service Date
            2.   Time In (Start)
            3.   Time Out (Finish)
            4.   Job Number (from timesheet)
            5.   Service Duration (total time in hours)
            6.   Staff Initials
            7.   Case Notes, if applicable

        Each Staff who documents on the form should complete the staff information on the bottom of the
        form.

        Staffs Supervisor must review, sign, and date form as well.

G.    This form should be turned in to the division secretary every two weeks along with the individuals’
      payroll timesheet.

H.    Each division secretary should send this original form along with a copy of the timesheets to the
      Fiscal Department.

I.    REIMBURSEMENT SUMMARY REPORT

            1. Title XX Service Logs and a copy of the individuals payroll time sheet shall be submitted
               by the Adult Service Providers/Community Service Providers every 2 weeks to the Fiscal
               Department.

            2. The Fiscal Specialist will reconcile the quarterly allocations on the Title XX Quarterly
               Summary.

            3. The Fiscal Specialist will complete the Title XX Quarterly Invoice.

            4. The Fiscal Specialist will compile and submit the Title XX Quarterly Report identifying the
               Title XX recipients and the total units billed for each individual.

            5. The Fiscal Specialist will submit these aforementioned quarterly reports to the Ohio
               Department of ODODD within fifteen (15) days of the end of each quarter. Via the online
               Title XX System.

J.   TITLE XX FEDERAL ASSISTANCE PROGRAM SUMMARY

     1. INTENT TO PARTICIPATE



                               Title XX Application For Eligibility-Redetermination
                                                   Page 2 of 3
                                                                                                  Effective 03/10




        a. It is the intent of the Warren County Board of Developmental Disabilities to participate in
           the Title XX federal assistance program through a contract/grant agreement with the Ohio
           Department of Developmental Disabilities. The purpose is to maximize use of the federal
           assistance program to carry out the grant program objectives of employment services for
           mentally retarded and developmentally disabled residents in the community.

  2. ADMINISTRATION REQUIREMENTS

        a. Administration of this contract shall include compliance in documentation and billing for
           grant funds. Services will be documented daily for each recipient showing the billing unit
           and number of units provided daily for the service of employment training. This log will
           be maintained locally as back up for the quarterly billing process. Billing will be
           completed according to required format and dates.

  3. ELIGIBILITY

        a. Determination for eligibility for participation in the Title XX federal assistance program will
           coincide with eligibility for Warren County Board of Developmental Disabilities services
           through the OEDI process. These services will be provided to eligible individuals without
           regard to income and/or resources. Re-determination of eligibility will be completed at
           the annual program plan review for each participant. This process will include review of
           Board services and benefits for participation in employment training services according to
           the individual plan. By indicating on the Individual Plan the individual participates in the
           Title XX Federal Assistance Program, this also serves as notice of approval of the Title
           XX Application.




APPROVED:


                                                                                 March 26, 2010
      Megan K. Manuel, Superintendent                                                Date




                          Title XX Application For Eligibility-Redetermination
                                              Page 3 of 3
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

TITLE XX DOCUMENTATION                                                                     SECTION 1.05



Purpose:

To uniformly document participation in the Title XX federal assistance program.

Procedure:

Agency Form AGF-081 will be used in addition to individual’s payroll timesheets to document participation
in the Title XX federal assistance program.

A.    Adult Service Providers/Community Service Providers should document daily on the Title XX Unit of
      Service Log the following information:

            Service Date
            Time In (Start)
            Time Out (Finish)
            Job Number (from timesheet)
            Service Duration (total time in hours)
            Staff Initials
            Case Notes, if applicable

B.    Each Staff who documents on the form should complete the staff information on the bottom of the
      form.

C.    Staff Supervisor must review, sign, and date form as well.

D.    This form should be turned in to the division secretary every two weeks along with the individuals’
      payroll timesheet.

E.    Each division secretary should send this original form along with a copy of the timesheets to the
      Fiscal Department.



APPROVED:


                                                                                  March 26, 2010
          Megan K. Manuel, Superintendent                                             Date




                                      Title XX Documentation Procedure
                                                 Page 1 of 1
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

TITLE XX REIMBURSEMENT SUMMARY REPORT                                                     SECTION 1.06



Purpose:
To ensure summary reports for reimbursement of Title XX Grant monies is completed accurately and in a
timely manner.

Procedure:

The following process shall occur to ensure timely submission of quarterly reports of Title XX Grant
monies:

A.   Title XX Service Logs and a copy of the individuals payroll time sheet shall be submitted by the
     Adult Service Providers/Community Service Providers every 2 weeks to the Fiscal Department.

B.   The Fiscal Specialist will reconcile the quarterly allocations on the Title XX Quarterly Summary.

C.   The Fiscal Specialist will complete the Title XX Quarterly Invoice.

D.   The Fiscal Specialist will compile and submit the Title XX Quarterly Report identifying the Title XX
     recipients and the total units billed for each individual.

E.   The Fiscal Specialist will submit these aforementioned quarterly reports to the Ohio Department of
     ODODD within fifteen (15) days of the end of each quarter.


APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                 Title XX Reimbursement Summary Report
                                               Page 1 of 1
                                                                                                 Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

AGENCY VOLUNTEER APPLICATION PROCESS                                                      SECTION 1.07



Purpose:

To ensure that all interested individuals who wish to volunteer for the agency follow the same procedure
and are afforded the same information regarding the various programs and opportunities within the
organization.

Procedure:

A.   All prospective volunteers shall obtain a volunteer packet and fingerprint card from the personnel
     office.

B.   The prospective volunteer will turn completed packets and fingerprint cards into the personnel
     office. The application form and emergency medical form shall be turned into the Quality Assurance
     Division by the personnel office.

C.   If the prospective volunteer is an individual who is eligible for DD County Board services, a full
     medical disclosure (Emergency Medical Authorization and General Information Form CRS-109) will
     be submitted to the Adult Services R.N. A completed Volunteer Job Description (AGF-079) will also
     be submitted. The R.N. will review the job description and complete a medical assessment (ASF
     030) and the RN will indicate if the individual will be able to independently complete the volunteer
     duties. If the RN indicates that the individual will not be able to independently work as a volunteer,
     the individual will be offered the same opportunity, as part of a day-program curriculum.

D.   The personnel office shall submit the fingerprint card for processing.

E.   Once the personnel office receives verification that the prospective volunteer has received a clean
     background check, the personnel office submits the verification to the Quality Assurance Division.

F.   The Quality Assurance Division will send a copy of the volunteers emergency medical form to the
     division the individual is interested in working for.

G.   The Division Director/designee shall inform the volunteer that they have been approved to begin
     volunteering.

H.   The Division Director/designee shall have the volunteer sign a job description (AGF-079) that
     outlines the type of work the volunteer will be doing.

I.   The Division Director/designee shall present the volunteer with a volunteer packet that contains at a
     minimum the following information:

            Copy of the Client Bill of Rights
            Appropriate Interaction Guidelines
            Confidentiality Information
            Agency and division brochures
            Information regarding ‘Hand Washing’
            Information regarding ‘Blood borne Pathogens’




                                   Agency Volunteer Application Process
                                               Page 1 of 2
                                                                                                 Effective 03/10




J.   The Division Director/designee         shall   have     the    volunteer   sign   a   Record           of
     Training (AGF-077).

K.   The Division Director/designee shall submit forms AGF-079 & AGF-077 to the Quality Assurance
     Director to put in the volunteers file.

L.   The Division Director/designee shall show the volunteer where the Volunteer Time Sheets (AGF-
     078) are kept and instruct them to fill the sheet out each time the person volunteers. The Division
     Director should route these time sheets to the Quality Assurance Director monthly.


APPROVED:


                                                                                March 26, 2010
        Megan K. Manuel, Superintendent                                             Date




                                  Agency Volunteer Application Process
                                              Page 2 of 2
                                                                                                     Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

AUTHORIZATION FOR USE/DISCLOSURE OF INFORMATION (HIPAA)                                     SECTION 1.08



PROCEDURE FOR REQUESTING AUTHORIZATION:

A.    In situations when an authorization is required, the individual authorizing the disclosure should
      complete the form AGF-102 “Warren County Board of DD Authorization for Use and Disclosure of
      Protected Health Information”.

B.    The receiving party can be an individual, an organization, or classes of individuals or
      organizations.

C.    Be meaningful and specific with the portion of the information to be released.

D.    Avoid specifying the entire consumer file unless absolutely necessary.

E.    Supply a reason for the release.

F.    The expiration date in general should be no more than one year from the date of the
      authorization.

G.    The individual or a person legally authorized to sign for the individual should be asked to approve
      the authorization and receive a copy.

PROCEDURE FOR PROCESSING AUTHORIZATION:

H.    The Privacy Officer should review the authorization against the criteria dictated in Policy Section
      1.07 (3-F: Core Elements for a Valid Authorization and Defective Authorizations) to verify the
      validity of the Authorizations) to verify the validity of the Authorization. For any defects, contact
      the consumer or his/her representative so that it can be corrected.

I.    Send the information as requested from the Individual Record.

J.    Place original authorization in the consumer file, and give or send a copy to the consumer or
      his/her representative.


APPROVED:


                                                                                    March 26, 2010
       Megan K. Manuel, Superintendent                                                  Date




                          Authorization for Use/Disclosure of Information (HIPAA)
                                                Page 1 of 1
                                                                                                        Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

INDIVIDUAL REQUST FOR AN ACCOUNTING OF DISCLOSURES (HIPAA)                                     SECTION 1.09



Individuals/guardians or personal representatives are entitled to an accounting of disclosures of their
records. In general, this accounting will include disclosures made for reasons other than Treatment,
Payment or Operations, and not authorized by the Individual.

Procedures

   A. Individuals who wish an accounting for disclosures will be directed to submit a written request to
      the Privacy Officer using the “Request for Accounting for Disclosures of Consumer File” Form.

   B. When the Privacy Officer receives a request, the Privacy Officer will review the individual’s file to
      determine if it contains documentation of a directive from law enforcement official or other
      authorized agency to suspend an accounting for disclosures. If such a directive exists, process
      the request, excluding the information which must be excluded, and include a note that it is
      impossible to complete the request because of a suspension required by law. At such time as the
      suspension is lifted, complete the request.

   C. The Privacy Officer will contact any business associates who may have released information for
      purposes other than treatment, payment, and operations, and not authorized by the patient.
      Request an accounting for disclosures to be provided within 15 days.

   D. Upon receipt of responses from business associates, if any, The Privacy Officer will complete a
      report. Use the log, “Accounting of Disclosures”, maintained in the Individual File plus business
      associate responses to document all disclosures, excluding those:

       1. For Treatment, payment, and operations
       2. Made to the individual
       3. Made pursuant to an authorization

   E. And complete the report

   F. The Privacy Officer will put a copy of the report in the Individuals file, and mail the original to the
      consumer.


APPROVED:


                                                                                       March 26, 2010
         Megan K. Manuel, Superintendent                                                   Date




                         Individual Request for an Accounting of Disclosures (HIPAA)
                                                  Page 1 of 1
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

MINIMUM NECESSARY USE AND DISCLOSURE (HIPAA)                                              SECTION 1.10



When providing minimum necessary PHI information, use the following guidelines as to the type of
information that should be released:

A. Information for Routine Disclosures

   1. Billing – Information required for billing will be disclosed to the contracted billing service using
      their forms or required documentation sheets, whenever a billable service is rendered.

   2. Mitchell & Associates Support – Information in INFALLIBLE system is incidentally available during
      system support activities. When support is necessary, the server telephone modem connection
      will be enabled and Mitchell & Associates will be called. When support is concluded, modem
      connection will be disabled.

   3. Job and Family Services – For summer camp program or other contracted programs, which is
      reimbursed by JFS TANF Program Funds. Submit roster of attending individuals with their social
      security numbers to JFS.

   4. Service Coordination with Mental Health Recovery Services. For coordination of care,
      psychological assessments and progress notes will be sent, along with any written
      communication from service coordinator, at the request of the service coordinator.

   5. Prosecutor’s office: When a warrant is presented, provide requested information.

   6. Rehabilitation Service Commission:. For individuals enrolled in Community Employment
      requested PHI will be provided.

   7. Residential Providers – New Contracts pertinent PHI information will be provided.

   8. ODODD MUI Department – When reporting MUI’s, pertinent PHI information will be submitted.

B. Procedures for Non-Routine Disclosures or Requests

   1. For non-routine disclosures, when subject to the minimum necessary provision, the Privacy
      Officer (or his/her designee) shall review the request for compliance with the minimum necessary
      requirements.

   2. For non-routine requests, the requesting party will utilize the minimum necessary principle.


APPROVED:


                                                                                March 26, 2010
        Megan K. Manuel, Superintendent                                             Date




                             Minimum Necessary Use and Disclosure (HIPAA)
                                             Page 1 of 1
                                                                                                    Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INDIVIDUAL REQUEST FOR CONFIDENTIAL COMMUNICATIONNS (HIPAA)                                   SECTION 1.11



Procedures

When an individual/guardian/personal representative requests confidential communications, including for
example, not sending information to their home address or telephoning their home number. These
requests will be honored to the extent that they can be reasonably accommodated with our administrative
systems.


A. Individual, or their parents or guardian, may make a request for confidential communications in writing
   to the Privacy Officer.

B. When the Privacy Officer receives a request, the privacy officer may not ask the reason for the
   request. The Privacy Officer shall contact the individual making the request to obtain an alternate
   means of contacting them (e.g. cell phone, PO Box, etc.). The individual will be informed at that time
   of steps the board will take to implement the request.

C. If existing systems are capable of administering the request, the privacy officer shall take necessary
   steps to implement the request, such as adjusted phone numbers or addresses in computer files or
   mailing lists.

D. The Privacy Officer shall document the request, and disposition, in the Individual file.

E. When needed, the Privacy Officer will make recommendations to the Superintendent of
   improvements necessary in computer systems or administrative procedures in order to implement
   reasonable requests for confidential communications.

APPROVED:


                                                                                   March 26, 2010
         Megan K. Manuel, Superintendent                                               Date




                          Individual Request for Confidential Communications (HIPAA)
                                                  Page 1 of 1
                                                                                                      Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INDIVIDUAL REQUEST FOR EXTRA RESTRICTIONS REGARDING USE &                                       SECTION 1.12
DISCLOSURE OF PHI (HIPAA)

PROCEDURE: If an individual/guardian/personal representative request extra restrictions over and
above the board policies regarding the use and disclosure of PHI, the following procedure shall occur:

A. As described in the Notice of Privacy Practices, individuals who desire restrictions are instructed to
   contact the Privacy Officer in writing.

B. The Privacy Officer will refer the request to the Division Director. At the Division Director’s Discretion,
   he/she shall consult with the appropriate Service Coordinator/Program Instructor/EI Specialist in
   making a recommendation. The request may be discussed with the individual for clarification if
   necessary.

C. The Privacy Officer and Division Director shall evaluate:

    1. The board’s ability to administer such a restriction, and the costs involved;
    2. The health/safety/welfare needs of the individual requesting the restriction;
    3. Whether the restriction requested is one of the Potential Restrictions defined in this policy.

D. Based on this evaluation, a recommendation shall be made to the superintendent who will either
   approve or deny the request.

E. The Privacy Officer shall inform the individual of the decision, and document the decision in the
   individual’s file, and implement the necessary steps to insure proper enforcement of the restriction.

F. As described in the Emergency Situations policy, these restrictions will not apply during an
   emergency. In the event these restrictions are broken in the course of an emergency, and
   information is disclosed to a health care provider, a request shall be made to that provider to not
   further use or disclose the information.

TERMINATION OF THE RESTRICTION:

A. In the event that the board wishes to terminate the restriction, the Privacy Officer or other staff
   member may request the termination with the individual. The individual’s written agreement to
   terminate the restriction must be filed in the Individual’s file, or if it is received verbally, that verbal
   agreement must be documented in the Individual’s file.

B. The board may unilaterally terminate the restriction. Such a termination without the individual’s
   agreement must be documented in the Individual File and the individual must be notified. Such a
   termination will apply only to Protected Health Information created after the date of the termination.

APPROVED:


                                                                                     March 26, 2010
          Megan K. Manuel, Superintendent                                                Date




              Individual Requests for Extra Restrictions Regarding Use & Disclosure of PHI (HIPAA)
                                                    Page 1 of 1
                                                                                                      Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

VERIFICATIOIN OF IDENTITY AND AUTHORITY OF ENTITIES                                              SECTION 1.13
REQUESTING PHI (HIPAA)

County board personnel will verify the identity of individuals, their parent/guardian, or personnel
representatives prior to releasing protected health information. County board personnel will verify the
identity and authority of public officials requesting PHI.

A. Verifying identity and authority of Public Officials:

    1. Where the person requesting the PHI is a public official, covered entities may rely, if such reliance
       is reasonable under the circumstances, on any of the following to verify identity when the
       disclosure of PHI is to a public official or a person acting on behalf of the public official.

        a. If the request is made in person, presentation of agency identification badge, other official
           credentials, or other proof of government status. If the request is in writing, the request is on
           the appropriate government letterhead; or

        b. If the disclosure is to a person acting on behalf of a public official, a written statement on
           appropriate government letterhead that the person is acting under the government's authority
           or other evidence or documentation of agency, such as a contract for services, memorandum
           of understanding, or purchase order, that establishes that the person is acting on behalf of
           the public official.

        c.   A written statement of the legal authority under which the information is requested, or, if a
             written statement would be impracticable, an oral statement of such legal authority.

        d. If a request is made pursuant to legal process, warrant, subpoena, order, or other legal
           process issued by a grand jury or a judicial or administrative tribunal is presumed to
           constitute legal authority.

        e. Disclosure to the Secretary of the Department of Health and Human Services is required for
           purposes of enforcing the Privacy regulation. When PHI is requested by the Secretary of the
           Department of Health and Human Services for compliance purposes, the covered entity must
           verify the identity of the requestor and their authority to access protected health information
           as would be required for any other law enforcement or oversight agency request for
           disclosure.

B. Verification Not Required in Emergencies:

    If there is an imminent threat to safety, it is lawful to disclose PHI to prevent or lessen a serious and
    imminent threat to the health or safety of a person or the public if disclosure is made to a person
    reasonably able to prevent or lessen the threat. If these conditions are met, no further verification is
    needed.

    In such emergencies, the covered entity is not required to demand written proof that the person
    requesting the PHI is legally authorized. Reasonable reliance on verbal representations is
    appropriate.


    a. Verifying the identify of an Individual, Parent, or Personal Representative who requests PHI:



                     Verification of Identity and Authority of Entities Requesting PHI (HIPAA)
                                                     Page 1 of 2
                                                                                                          Effective 03/10




       Before divulging PHI to anyone, the identity of the individual must be verified. This applies for
       individuals, their parents/guardians, or their personal representatives. Any one of the following
       below is sufficient to verify the identity of the requestor:

     i.      If the staff member knows the requestor, the identity is verified. This includes recognizing
             someone who appears in person, or recognizing his or her voice over the phone. A staff
             member may ask another staff member who knows the requestor to verify their identity.

    ii.      If the requestor appears in person, an drivers license or photo ID is sufficient verification.

    iii.     If the requestor is calling on the telephone (or is in person but does not have a photo ID),
             their knowledge of one or more pieces of information, such as the individual’s social security
             number, date of birth, address, or other piece of information shall be sufficient to verify their
             identity. The exact information requested is at the discretion of the staff member. In the
             event of suspicion that the requestor is not who they say, professional judgment should be
             employed and more information should be requested.


APPROVED:


                                                                                         March 26, 2010
           Megan K. Manuel, Superintendent                                                   Date




                      Verification of Identity and Authority of Entities Requesting PHI (HIPAA)
                                                      Page 2 of 2
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

SAFEGUARDING INFORMATION (PAPER, ORAL, AND                                                 SECTION 1.14
ELECTRONIC DATA (HIPAA)


This procedure is established to protect the integrity of the Board’s data and computer systems and the
security and privacy of Protected Health Information (PHI).

Data Storage/Usage
A. All data must be stored on the file server to ensure its protection. Files should not be stored on
   individual computers. Printed information that is considered confidential should never be left on an
   unattended printer, photocopier, or fax machine unless the device is located in a secure area that is
   limited to authorized staff.

B. All data access will be controlled by the use of a user id and password. It is the responsibility of the
   person's immediate supervisor to request necessary security clearance for an individual. The
   immediate supervisor will forward this request to the Chief Financial Officer who will in turn request
   the appropriate security clearances for the individual user through the IS Department. An individual
   may not request changes to his/her own accounts. Verbal requests for security changes will not be
   honored except in an emergency. When a verbal request is received and honored, a follow-up
   request must be received.

C. It is the responsibility of the immediate supervisor to notify the IS Department as soon as a
   resignation or other separation notice is received from an employee. This notice must include the
   separation date so the individual's security will expire on that date.

D. All PHI related information must be stored on a secure drive and will only be accessible to individuals
   with Security Clearance or the staff members personal network drive (H: drive).

E. System backups of all file server data are performed by the Warren County Data Processing
   Department.

Computer Security
A. Employees or contractors are expected to be vigilant in maintaining system security. Individuals may
   not attempt to or break into system security, or exceed authorized limits when accessing any
   computer networks.

B. The entry or distribution of any self-replicating code, any file which may cause damage to any
   computer system, or any “computer virus” is prohibited. Diskettes and other electronic media from
   outside the agency must be scanned for viruses before being used on the Board’s computers. This
   includes media used on home computer systems

C. No employee or contractor shall login to any system with any identification or password other than
   that assigned to them except for authorized IS personnel for troubleshooting/testing purposes.
   Employees or contractors shall not divulge their network or database, or State Assigned passwords to
   anyone except for authorized IS personnel. All system passwords shall be changed on a periodic
   basis unless other policies apply to those specific systems.

D. Any work done under an individual’s user ID and password shall be assumed to have been done by
   that person, and any consequences of that work shall fall to the individual under whose name the
   work was done, including malicious damage done to files and data which are the property of the
   Board.
E. Employees or contractors shall also follow all account authorization processes, login procedures and
   password protection features established by the IS Department.

                                     Safeguarding Information (HIPAA)
                                               Page 1 of 2
                                                                                                   Effective 03/10




F. Any employee or contractor who suspects or detects a breach of security shall immediately notify the
   System Administrator or an available Supervisor, who shall report the breach to the System
   Administrator.

G. Each employee or contractor using the system must logoff the system at the end of the individual’s
   workday or whenever the person is not physically in the area of the computer for an extended period
   of time. Remember, if you do not log off your account, anyone can access your information, e-mail,
   etc., and all activities shall be recorded under your account name.

H. Employees or contractors shall not attempt to alter or reconfigure the computer equipment, network
   settings, dial-up connections or printers without authorization from the IS Department. No employee
   or contractor shall tamper with, or disable any security software installed on a Board computer. This
   includes, but is not limited to, Internet filtering software, virus software, and auditing software.

I.   All electronic mail (e-mail) messages containing PHI shall include a notice that the contents of the e-
     mail is protected and not to be disclosed.

Faxing Security
A. Fax machines shall be located in areas where public access is limited, and where the public cannot
   easily see fax contents.

B. A cover page with a notice that the content of the fax is protected and not to be disclosed shall
   accompany all fax documents containing PHI. The cover page shall also contain instructions for an
   errant recipient requesting that the fax be shred and The Warren County Board of DD be notified
   immediately of the error.

C. Confidential information shall never be left unattended on a fax machine.

File Security:
A. All files shall be kept in a locked/secured area. Information should not be left our in work areas when
    not being used.

Oral Communication Security:
A. Discussion regarding an individuals PHI should be held in private, where it cannot be overhead and
   limited to ‘need to know’ information.

APPROVED:


                                                                                  March 26, 2010
          Megan K. Manuel, Superintendent                                             Date




                                      Safeguarding Information (HIPAA)
                                                Page 2 of 2
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE
NOTICE OF PRIVACY (HIPAA)                                                                   SECTION 1.15



Procedure:
To ensure that all enrolled individuals/guardians/personal representatives shall receive a HIPAA Notice of
Privacy no later than April 14, 2003. Annually thereafter, each individual will be provided information
regarding the availability of the notice and will be provided with one if they request it.

A. The Service Coordinator/Case Manager/EI Specialist/designee shall send out the ‘Notice of Privacy’
   to each enrolled individual/guardian/personal make a good faith effort to obtain a written
   acknowledgment of receipt of the initial notice.

B. If this acknowledgement is not obtained, the Service Coordinator/EI Specialist/designee shall
   document the efforts to obtain such an acknowledgment.

C. The Notice of Privacy will be available at all program sites.

D. The Notice of Privacy will be available on the agency web site.

E. Should information change regarding the use or disclosure of PHI, the individual’s rights, the Board
   legal duties or other privacy practices, the Privacy Officer shall provide a notice of such changes to all
   enrolled individuals. These changes shall be made no later than 60 days after the change is
   effective.


APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                          Notice of Privacy (HIPAA)
                                                 Page 1 of 1
                                                                                              Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

MEDICAID ADMINISTRATIVE CLAIMING                                                      SECTION 1.16


PURPOSE: To provide a uniform method of tracking staff activity for billing purposes regarding
individuals served as required in 5123:1-2-08.

PROCEDURE:

A.     QUARTERLY TIME STUDY MEDICAID ADMINISTRATIVE CLAIMING ACTIVITIES

       1. The MAC Coordinator will select all employees who are to participate in the time study. This
          list is pre-determined and in accordance with the county MAC plan submitted to ODODD for
          approval each calendar year.

       2. Employees who are participating will have MAC systems and procedures reviewed on a
          quarterly basis, via training from the county MAC Coordinator.

       3. Employees are to utilize the ORODD online system for data entry. Employees will document
          their time in the online MAC system provided by ODODD.

       4. Supervisors are to review the employee data entry information at the completion of the week
          for accuracy. Supervisors will compare employee timesheets versus MAC billing hours to
          assure that the totals match. Any questions should be forwarded to the MAC Coordinator.

       5. The MAC Coordinator (Medicaid Manager) will then review the coding for accuracy. The
          MAC Coordinator will then create a quarterly invoice billable to ODODD once accuracy is
          again checked.

       6. All MAC related information will be kept with the WCBDD MAC Coordinator.          Any MAC
          related questions are to be directed to the county MAC Coordinator.



APPROVED:


                                                                             March 26, 2010
        Megan K. Manuel, Superintendent                                          Date




                                   Medicaid Administrative Claiming
                                             Page 1 of 1
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

PAYMENT AUTHORIZATION FOR WAIVER SERVICES (PAWS)                                          SECTION 1.17


PURPOSE:

To ensure adequate services with funds available, the Warren County Board of DD is responsible for
approving all Individual Service Plans for Level One Waiver, Individual Options Waivers and Residential
Facilities Waivers costs. The Payment Authorization for Waiver Services (PAWS) form is the document
that authorizes payment for these services.

PROCEDURE:

A. Individual Service Plans (ISP) for individuals receiving Level One Waiver, Residential Facility Waiver
   and Individual Options Waiver services are developed by Service Coordinators and the individual
   support team for the individual served. The health and safety of the individual served are always
   foremost when developing these individual service plans.

B. The Service Coordinator presents hours of service required per the Individual Service Plan (ISP) to
   the Medicaid Manager for approval and for contract development. Any change in services will be
   approved by the Community Resource Director to ensure funds are available to meet the identified
   needs. Changes for services require a 10 working day waiting period for implementation and begins
   when the Medicaid Manager has received the protocol.

C. Once the Medicaid Manager approves services and ensures that funds are available, the Medicaid
   Manager completes the PAWS form and forwards it to the CRS Director for approval. WCBDD then
   enters the PAWS into the online ODODD PAWS system.

D. ODODD enters the PAWS into their billing system and then returns PAWS Verification to the
   Medicaid Manager.

E. The Medicaid Manager/Designee sends a copy of the PAWS Verification to the Waiver Service
   Provider(s) and individual’s home address, which serves as verification to provider and individual that
   PAWS are in place, and services are authorized for billing. The Provider should not submit billing
   until they have received the PAWS Verification form.


APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                             Payment Authorization for Waiver Services (PAWS)
                                                Page 1 of 1
                                                                                                    Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

ADULT DAY WAIVER SERVICES REQUEST FOR                                                      SECTION 1.18
ADMINISTRATIVE REVIEW

PURPOSE:        Administrative review should be utilized on individualized basis and should be based
upon individual need. This procedure defines the process for making such requests.

PROCEDURE:

A. All individuals receiving adult day support, vocational habilitation, supported employment enclave, or
   supported employment community waiver services must have an acuity assessment completed and
   scored. This score will assign a budget.

B. In order to request an administrative review the SSA must identify specific supervision needs that
   were not accounted for in the acuity assessment.

C. Individuals can only move up one acuity range.

D. Individuals in acuity group C are not eligible for administrative review.

E. The SSA will submit a request for administrative review to the Financial Oversight Committee and will
   include a summary of why this person’s needs exceed their current acuity score.

F. The Financial Oversight Committee will review the request for administrative review within 5 days.
   The committee will attach documentation and will forward to the superintendent with either a. a
   recommendation for approval, or b. a recommendation for denial with due process documents
   attached.

G. The superintendent and/or designee will review all requests within 5 days and will either a. approve a
   request for administrative review or b. deny the request for administrative review and will include due
   process documents.




APPROVED:


                                                                                   March 26, 2010
          Megan K. Manuel, Superintendent                                              Date




                         Adult Day Waiver Services Request for Administrative Review
                                                 Page 1 of 1
                                                                                                     Effective 03/10




                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

INDIVIDUAL INFORMATION FORM (IIF)                                                               SECTION 1.19


PURPOSE:        The Individual Information Forms (IIF) represents the only census available for the Ohio
Department of Developmental Disabilities (ODODD) community service system. This information
provides ODODD accurate and timely information regarding enrolled individuals to study the way
individuals use services now, and to plan for future services. Annually, each IIF will be reviewed and
updated, if applicable. Additionally, the IIF will be updated as an individual changes service areas,
residence, etc.

PROCEDURE:

A. INITIAL IIF:

     An IIF shall be completed upon initial determination of eligibility for agency services.

     1. All information that is entered on the IIF shall be done in RED ink.

     2. Upon entry into the agency, the Intake Coordinator or the Early Intervention Secretary will
        complete the IIF.

     3. The IIF will be sent to the Service & Support Administration Assistant Director or the Early
        Intervention Supervisor for review.

     4. The Service & Support Administration Assistant Director will forward the IIF to the Fiscal
        Specialist to update the IIF online system.

B. UPDATING AN IIF:

     The IIF shall be updated when changes occur in programming or residential settings.

     1. All information that is changed on the IIF shall be done in RED ink.

     2. Each IIF shall be updated if changes occur in:
        a. Programming – the Early Intervention Secretary, Program Instructor, or Family Services
           Coordinator shall update the IIF.
        b. Residential – The IIF shall be updated by the Service Coordinator.

     3. The IIF will be sent to the Service & Support Administration Assistant Director or the Early
        Intervention Supervisor for review.

     4. The Service & Support Administration Assistant Director or the Early Intervention Supervisor will
        forward the IIF to the Fiscal Specialist to update the IIF online system.

C.       THE ANNUAL UPDATE/REVIEW OF ALL IIF’S:

         1. The Fiscal Specialist will print out all IIF’s in mid-August of each year.

         2. The Fiscal Specialist will distribute the IIF’s to the appropriate divisions for review/updates.

         3. The IIF’s will be updated/reviewed by:



                                         Individual Information Form (IIF)
                                                    Page 1 of 2
                                                                                                 Effective 03/10




        a.   EI – Early Intervention Secretary
        b.   Adult Services – Program Instructor
        c.   Family Services – Family Services Coordinator
        d.   Service Coordination – Service Coordinator

             After completing the update/review, the IIF’s will be returned to the Fiscal Specialist.

     4. The Fiscal Specialist will input the information into the ODODD online IIF system annually at
        a date determined by ODODD.

     5. The Fiscal Specialist will keep a copy of the IIF’s and forward the originals to the SSA
        Division File Secretary.


APPROVED:


                                                                                March 26, 2010
      Megan K. Manuel, Superintendent                                               Date




                                    Individual Information Form (IIF)
                                               Page 2 of 2
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

ACUITY ASSESSMENT                                                                           SECTION 1.20



PURPOSE:          The ODODD Acuity Assessment Instrument (AAI) is the standardized instrument used to
assess the relative needs and circumstances of an individual compared to other adults in a non-
residential setting when receiving one or more of the Adult Day waiver services. Administrative Rule
5123:2-2-19. This Procedure is to establish how these Acuity Assessments will be completed for those
receiving Adult Day waiver services in Warren County.

PROCEDURE:

A. Individuals requesting Adult Day waiver services must have an Acuity Assessment Instrument (AAI)
   completed prior to receiving these services.

B. The Acuity Assessment Instrument (AAI) should be completed by an individual trained and certified in
   completion of the AAI by the Ohio Department of DD. A Primary Informant should be utilized in the
   completion of the AAI. The Primary Informant should be the person who best can indicate the
   assessed individuals needs and circumstances in a non-residential setting. The person completing
   the AAI can be the Primary Informant if they are certified to complete the AAI.

C. The completed AAI will be given to the Service Coordinator for that individual for review, clarification,
   and entering of the AAI into the online electronic scoring system.

D. If the Service Coordinator disagrees with answers provided in the AAI they will review their concerns
   with the SSA Director or designee then will contact the individual who completed the AAI and the
   Informant to reassess the answer and to reach consensus prior to entering it into the AAI online
   electronic scoring system.

E. Once the AAI is entered into the AAI online electronic scoring system, a score will be automatically
   calculated. The Service Coordinator will provide a copy of this score to the individual, the individual’s
   guardian if applicable, the Adult Day Waivers Services Provider, and the Medicaid Manager. The AAI
   score will also be entered into the individual’s ISP Attachment B.

F. The AAI can be rescored anytime there is a change in the individual’s status that might affect their
   AAI Score.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                        Acuity Assessment Procedure
                                                 Page 1 of 1
                                                                                               Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

ADULT DAY WAIVER SERVICES – REQUEST FOR ADMIN. REVIEW                                    SECTION 1.21



PURPOSE/GOAL:           Administrative review should be utilized on individualized basis and should be
based upon individual need. This procedure defines the process for making such requests.

PROCEDURE

   1. All individuals receiving adult day support, vocational habilitation, supported employment –
      enclave, or supported employment community waiver services must have an acuity assessment
      completed and scored. This score will assign a budget.

   2. In order to request administrative review SSA must identify specific supervision needs that were
      not accounted for in the acuity assessment.

   3. Individuals can only move up one acuity range.

   4. Individuals in acuity group C are not eligible for administrative review.

   5. SSA will submit a request for administrative review to Financial Oversight Committee and will
      include a summary of why this person needs exceed their current acuity score.

   6. The Financial Oversight Committee will review the request for administrative review within 5 days.
      The committee will attach documentation and will forward to the superintendent with either A)
      recommendation for approval, or B) recommendation for denial with due process documents
      attached.

   7. Superintendent and/or designee will review all requests within 5 days and will either A) approve
      request for administrative review or B) Deny request for administrative review and will include due
      process documents.




APPROVED:


                                                                       March 26, 2010
Megan K. Manuel, Superintendent                                        Date




                           Adult Day Waiver Services – Request for Admin. Review
                                                Page 1 of 1
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INCLEMENT WEATHER/CALAMITY DAY PROCEDURE                                                    SECTION 1.22


PURPOSE:        To provide for the safe and efficient transportation of individuals in the event of inclement
weather or other calamity.

PROCEDURE:

A.      SUPERINTENDENT DECISIONS:

            The Operations Director and the Transportation Supervisor will check the road conditions and
            will advise the Superintendent of the need for any delays or closings. If a delay or closing is
            appropriate the Transportation Supervisor will notify Springmeyer, the local media-closing
            network that notifies radio and T.V. stations and notify transportation providers that are
            contracted by DD. (Warren County Transit)

            In the absence of the Superintendent, the Assistant Superintendent will consult with the
            Operations Director and the Transportation Supervisor regarding the need for delays and
            closings.

            Announcements broadcast over radio and television pertains to individuals served only,
            unless “staff” is specifically mentioned.

            The following options will be utilized in regard to delays and closings:

            1. “Warren County Board of DD Transportation Two Hour Delay”: Individuals served riding
               DD vehicles or utilizing DD contracted carriers will be picked up approximately two hours
               later than usual. All other individuals served may arrive at their regular time or up to 2
               hours later.

                The following staff are to report at their normal time:

                       a.   Administration
                       b.   Community Resources
                       c.   Early Intervention
                       d.   Business Services
                       e.   Operations
                       f.   Quality Assurance
                       g.   Service and Support Administration

                             1. Adult Services – follow division procedure
                             2. Transportation – follow division procedure

            2. “Warren County Board of DD Open/No DD Transportation”: Individuals served riding DD
               vehicles or utilizing DD contracted carriers will not be picked up. All individuals served
               may make their own arrangements to attend programming.

                The following staff report at their normal time.
                .
                      a. Administration
                      b. Community Resources
                      c. Early Intervention


                                       Inclement Weather/Calamity Day
                                                 Page 1 of 3
                                                                                              Effective 03/10




                  d.   Business Services
                  e.   Operations
                  f.   Quality Assurance
                  g.   Service and Support Administration
                  h.   Adult Services

                        1. Transportation – follow division procedure

        3. “Warren County Board of DD Closed”: The agency is closed. No individuals served are
           to report.

            The following staff are to report at their normal time:

                  a.   Administration
                  b.   Community Resources
                  c.   Early Intervention
                  d.   Business Services
                  e.   Operations
                  f.   Quality Assurance
                  g.   Service and Support Administration
                  h.   Adult Services

                        1. Transportation – follow division procedure

B.   EMERGENCY CLOSING DURING THE DAY: ALL DIVISIONS

        In the event that any day program closes due to weather/emergency conditions, the following
        procedure should be followed.

     1. The Superintendent/Designee will immediately be notified of any conditions that may require
        program closing.

     2. The Superintendent/Designee will make the decision in regard to closings.

     3. The Superintendent/Designee will notify the Transportation Supervisor that the program is to
        be closed.

                  a.    The Transportation Supervisor will notify Springmeyer Communications of
                        the closing so that closings can be announced on local T.V./radio stations.
                  b.    The Transportation Supervisor will direct office staff to contact all ICFMR
                        Providers of the closing. This includes:

                        1. Warren County Transit

     4. The Superintendent/Designee will notify the Adult Services Director that the program will be
        closed.

                  a.    The Adult Services Director/Designee will notify Adult Services staff of the
                        closing.
                  b.    The Adult Services Director/Designee will direct staff to notify families of the
                        closing. Individuals served will not leave the program until there is
                        confirmation that someone is at home to meet their needs.
                  c.    The Adult Services Director/Designee will ensure that staff remains available
                        until all persons served have arrived at home.




                                   Inclement Weather/Calamity Day
                                             Page 2 of 3
                                                                                                 Effective 03/10




     5.     The Superintendent/Designee will notify the Service and Support Director that the program
            will be closed.

                    a.    The Service and Support Director/Designee will notify Service and Support
                          staff of the closing.
                    b.    The Service and Support/Designee will direct staff to notify all Supported
                          Living and Residential Facility Waiver Providers of the closing. Individuals
                          served will not leave the program until there is confirmation that someone is
                          at home to meet their needs.
                    c.    The Service and Support Director/Designee will ensure that staff remains
                          available until all persons served have arrived at home.

     6.     The Superintendent/Designee will notify the Business Services Division, Operations
            Division, QA Division, Community Resources Division Staff based at Milo H. Banta Center
            that the Agency is closing and at what time they should leave.

     7.     The Superintendent/Designee will notify the EI Coordinator of Services that the program
            will be closed.
                     a.     The Supervisor will notify staff.
                     b.     Staff will notify scheduled parents/families of the closing. Any scheduled
                            home visits should be cancelled and rescheduled.
                     c.     Staff will remain at Warren C. Young Center until all children/families have
                            left the facility.

     8.     All parents/providers/guardians are responsible for making emergency arrangements for
            individuals enrolled. If an individual is to be brought to another location (other than their
            scheduled     drop-off    location),    parents/providers   must     notify   the    Service
            Coordinator/Program Instructor, so that the Transportation Division can be notified.

C.   PAYMENT DURING INCLEMENT WEATHER/CALAMITY DAY

            1.    Employees, who are absent, but in active pay status on a day when staff are
                  instructed NOT to report due to weather/calamity conditions, shall be paid as if they
                  had been at work and their prior-approved leave, shall not be docked. Employees
                  who are in a no-pay status will not receive compensation for a calamity day.

            2.    Employees that are instructed not to report for work will be paid their regular hours for
                  that day. Employees that are deemed to be “essential staff” either for that day
                  specifically or all such days, shall report to work as required by their Supervisor.
                  (Hours worked on these occasions DO NOT entitle the employee to “double time”
                  pay.


APPROVED:


                                                                                March 26, 2010
      Megan K. Manuel, Superintendent                                               Date




                                    Inclement Weather/Calamity Day
                                              Page 3 of 3
                                                                                                    Effective 03/10




                       WARREN COUNTY BOARD OF MENTAL RETARDATION
                             AND DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

TRANSITION PLAN FOR THOSE RECEIVING ALTERNATIVE SERVICES                                     SECTION 1.23



PURPOSE:
To develop a transition plan with the goal of enhancing public safety for those with offending behaviors
that have substantially achieved the highest level of demonstrating positive behavioral changes as
identified within the Individual Service Plan and Behavior Support Plan. In order to ensure the health and
safety of the enrolled individual and community, the transition plan will identify services and supports the
individual will receive in residential, vocational, educational, social, and community settings.

PROCEDURE:

    A.    TRANSITION PLANNING

            1.       In order to initiate discussion regarding transition, the individual must achieve the
                     highest level (100% skill development/goal achievement) of appropriate and positive
                     behavioral changes as identified within the Individual Service Plan (ISP), Behavior
                     Support Plan (BSP), and with unanimous recommendation of the Interdisciplinary
                     Team (IDT), which is made up of representatives of the Warren County Board of DD
                     (WCBDD), residential services provider, and contracted professional(s).
            2.       After six (6) months of demonstrating positive behavior as outlined in ISP and BSP,
                     IDT will obtain a current risk assessment from an impartial professional source and
                     complete a written report for the WCBDD Superintendent recommending that
                     individual move to a less restrictive setting.
            3.       Upon Superintendent approval, IDT will begin identification of necessary services and
                     supports the individual will receive in residential, vocational, educational, social, and
                     community settings.
            4.       In the event the individual has involvement with the legal system, including Common
                     Pleas Court of Warren County, Warren County Juvenile Court, Warren County
                     Probate Court, Warren County Prosecutor, Warren County Sheriff, etc., the
                     Superintendent or designee will notify the respective authorities of proposed
                     transition plan for final approval prior to any change of residence.

    B.   TRANSITION – HEALTH AND SAFETY

            1.       Once IDT, Superintendent, and legal authority (if applicable) approve proposed
                     transition plan, coordination of services begins.
            2.       Due to WCBDD’s obligation to ensure the health, welfare, and safety of the individual
                     and community, individual will receive direct line of sight supervision (each plan
                     should specify i.e., Within 25 - 30 yards if outside, within the same room, etc.) in all
                     community settings and will not have any period of unsupervised time in any
                     environment.
                        a. Based upon the risk assessment, ISP, and/or BSP, same sex staff may be
                            required to accompany individual on community outings (i.e., have had MUI’s
                            regarding bathroom issues – staff leaving individual to use restroom).
                        b. If the individual’s family/guardian/natural unpaid support choose to spend any
                            amount of time with the individual away from the residential setting, that
                            person(s) assumes total responsibility for supervision and delivery of services
                            as outlined in the individual’s ISP.
            3.       IDT will develop a revised ISP that addresses services and support to be provided in
                     the following life domain areas:
                            Transition Plan for Those Receiving Alternative Services
                                                   Page 1 of 2
                                                                                                     Effective 03/10




                    a. Housing
                    b. Vocational/Day Habilitation/Community Employment/Educational
                    c. Community Membership
                    d. Personal Income
                    e. Choices and Options
                    f. Personal Satisfaction
                    g. Health
                    h. Safety
           4.     A Relapse Prevention Plan will be completed by contracted professional that
                  identifies strategies to cope with triggers that will assist in the prevention of relapse of
                  inappropriate or undesired behaviors.
           5.     In the event the individual requires formal or informal behavioral interventions, such
                  will be identified in ISP and BSP (if applicable).
           6.     Individual will meet with professional(s) at least one time per month to monitor
                  progress as well as determine if any relapse of undesired actions or thoughts exists.
           7.     IDT will develop outline of desired behavior for residence that will be incorporated
                  into ISP.

   C.   CONTINUATION OF SERVICES

           1.     Individual progress will be monitored regularly by team members that provide service
                  and support.
           2.     At least on an annual basis, a risk assessment may be completed by an impartial
                  professional source to determine the likelihood of any relapse of undesired behaviors
                  exists.
           3.     Services in ISP will ensure the health, welfare, and safety of the individual as well as
                  the overall community.
           4.     In the event the individual’s services needs change, WCBDD will modify existing ISP
                  to ensure the required level of intervention is provided to ensure the health, welfare,
                  and safety of the individual and community.
           5.     In the event that an individual/guardian disputes any action related to this procedure,
                  WCBDD will provide individual/guardian appeal rights as outlined in the WCBDD
                  Policy Manual.




APPROVED:


                                                                                    March 26, 2010
Megan K. Manuel, Superintendent                                                         Date




                         Transition Plan for Those Receiving Alternative Services
                                                Page 2 of 2
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

TRANSPORTATION SUBSIDY FOR SERVICES IN EXCESS OF BUDGET                                     SECTION 1.24



PURPOSE:        To develop a methodology for determining a personal contribution for services provided
                in excess of the transportation budget, contingent upon the individuals income.

PROCEDURE:

  A.   BUDGET ESTABLISHMENT

           1.      In order to maximize the funding available to individuals receiving services, a
                   spreadsheet has been developed to determine the individual’s contribution to
                   services desired that exceed the funding budget. If an individual depletes their
                   funding budget, the Board may subsidize transportation costs, based upon the
                   availability of funding and the calculations contained in the budget spreadsheet. The
                   Superintendent will determine annually the amount of money available for
                   transportation subsidies.

  B.   BUDGET SPREADSHEET

           1.      The budget spreadsheet must contain information and verification (ie, copies of
                   checks, tax returns, etc.) of all funding received by the individual. A monthly
                   allowance of 42% of income is given for housing, 14% of income for food and
                   hygiene and 18% for disposable income allowance.
           2.      The calculation for transportation subsidy is based upon the individual contributing
                   18% of net income after allowances, for the portion of the budget year that will be
                   unfunded.
           3.      The budget spreadsheet will be redone annually, or if income changes occur.



APPROVED:


                                                                                    March 26, 2010
       Megan K. Manuel, Superintendent                                                  Date




                          Transportation Subsidy for Services in Excess of Budget
                                               Page 1 of 1
                                                                                                      Effective 11/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

FINANCIAL OVERSIGHT COMMITTEE                                                                  SECTION 1.25


PURPOSE/GOAL:

The purpose of this procedure is to communicate to all staff and stakeholders the requirements and
functions of the Financial Oversight Committee.

DEFINITIONS:

Center for Medicare and Medicaid Services (CMS) 1915 waiver instructions:

Assistive Equipment – can be a device that is used to increase, maintain or improve the functional
capabilities of a person with a disability or a service that directly assists a person with a disability in the
selection, acquisition, or use of an assistive technology device. Examples of assistive equipment include
augmentative communication devices, which assist a person who cannot communicate through speech to
communicate with others, and adaptive equipment, which assists a person to write (such as an adapted
pencil or arm brace), or move objects in the person’s environment (such as a switch or remote control
device).

Environmental Accessibility Modifications are adaptations made to a home required by the individual’s
ISP to allow for easier and safer access due to specific needs resulting from a disability. These physical
adaptations are necessary to ensure health; welfare and safety of the participant or enable the individual
to function with greater independence in the home. Such adaptations include the installation of ramps
and grab bars, widening doorways, modification of bathroom facilities or the installation of specialized
electric and plumbing systems that are necessary to accommodate the medical equipment and supplies
that are necessary for the welfare of the participant. Excluded are those adaptations or improvements to
the home that are of general utility and are not of direct medical or redial benefit to the participant.
Adaptations that add to the total square footage of the home are excluded from this benefit except when
necessary to complete an adaptation.

Home accessibility adaptations may not be furnished to adapt living arrangement that are owned or
leased by providers of waiver services.

Precluded is installation of carpet or air conditioning and roof repairs.

Specialized Medical Equipment and Supplies include (a) devices, controls or appliances specified in the
individual’s ISP, that allow the individual to increase their ability to perform activities of daily living; (b)
devices, controls or appliances that enable the participant to receive, control or communicate with the
environment in which they live; (c) items necessary for life support or to address physical conditions along
with ancillary supplies and equipment necessary to the proper functioning of such items; (d) other durable
and non-durable medical equipment not available under the State Plan that is necessary to address
participant functional limitations; (e) necessary medical supplies not available under the State Plan.

Vehicle Modifications are adaptations to an automobile or van that is the waiver participant’s primary
means of transportation in order to accommodate the special needs of the participant. The following are
specifically excluded:

                Adaptations or improvements to the vehicle that are of general utility, and are not of
                 direct medical or remedial benefit to the individual;
                Purchase or lease of a vehicle;


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               Regularly scheduled upkeep and maintenance of a vehicle except upkeep and
                maintenance of modifications;
               Payment may not be made to adapt the vehicles that are owned or leased by paid
                providers of waiver services.

Funding Range is the dollar range to which an individual has been assigned for the purpose of funding
waiver services. The funding range applicable to an individual is determined by the score derived from an
assessment using the ODDP.

Individual Funding Level means the total funds, calculated on a twelve month basis, that are necessary
for payment for waiver services that have been determined through the individual service plan (ISP)
development process to be sufficient in amount, duration and scope to meet the health and welfare needs
of an individual.

Prior Authorization – mechanism for funding services when the individual funding level exceeds the
funding range determined by the Ohio developmental disabilities profile (ODDP). ODMRDD shall prior
authorize waiver services when the CBDD cannot recommend an ISP that ensures the health and welfare
of the individual within the assigned funding range and all following conditions are met:

           Waiver services are medically necessary and they are appropriate to the individual’s health
            and welfare needs, living arrangement, circumstances and expected outcomes and
           Are of appropriate type, amount, duration, scope and intensity; and
           Are the most efficient and effective services that when combined with other non-waiver
            services, ensure the health and welfare of the individual receiving the services; and
           Protect the individual from substantial harm expected to occur if the requested services or not
            authorized.

And, at least one of the following criteria must be met:

    *   Episodes of injury to self or others that have occurred within the last three months when there is a
        continuing risk of injury to self or others
    *   Presence of consistent behaviors in which the individual displays all of the following:
            o Lacks impulse control; and
            o Exhibits purposeful, dysfunctional goal-directed behavior to obtain or avoid something;
                  and
            o Requires constant monitoring and continual redirection and/or behavioral intervention; or
    *   Presence of a progressive medical condition or mental illness that is generally associated with:
            o Behaviors posing a risk to self or others; and
            o Requiring a controlled environmental to maintain health and safety; or
    *   Presence of a medical condition which, without staff intervention, would threaten the individual’s
        medical stability; or
    *   Inability of an unpaid caregiver to provide previous levels of support and/or to provide the level of
        support currently required; or
    *   Alterations in staffing ratios resulting from circumstances beyond the control of the individual.
        Examples may include the loss of a roommate or a change in the individual’s vocational
        schedule; or
    *   An emergency situation that creates for the individual a risk of substantial self-harm or substantial
        harm to others if action is not taken within thirty days. An emergency may involve:
            o Abuse, neglect or exploitation of the individual;
            o Health and safety conditions that pose a serious risk to the individual or others, including
                  immediate harm or death;
            o Changes in the emotional or physical condition of the individual that necessitate
                  substantial accommodations that cannot be reasonably provided by the individual’s
                  caretaker


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Individual Budget is a funding mechanism where an allocation is granted to an individual in which they
have the freedom and control to determine the use of the funds to give them a more meaningful life.

Acuity Assessment Instrument is the standardized instrument used by ODODD to assess the relative
needs and circumstances of an individual compared to other adults in a non-residential setting when
receiving one or more of the Adult Day waiver services.

MAXIMUM REIMBURSEMENT:

Individual Options (IO) Waivers – Cost of modifications and equipment are part of annual service cost and
when combined with all other services (except day array services including non-medical transportation
and supported employment) must be within ODDP Funding Range.

    o    Adaptive and Assistive/Vehicle Equipment - $10,000 (item)
    o    Environmental Accessibility - $7,500 (item)

Level One Waivers –

    o    Specialized Medical Equipment and Supplies - $2,000 within a period of three consecutive years
         beginning with the individual’s initial date of enrollment on the waiver; or $6,000 if prior approval
         is obtained and the combined payments for environmental accessibility adaptations, personal
         emergency response systems and specialized medical equipment and supplies does not exceed
         $6,000 within a period of three consecutive years beginning with the individual’s initial date of
         enrollment on the level one waiver.
    o    Environmental Accessibility - - $2,000 within a period of three consecutive years beginning with
         the individual’s initial date of enrollment on the waiver; or $6,000 if prior approval is obtained and
         the combined payments for environmental accessibility adaptations, personal emergency
         response systems and specialized medical equipment and supplies does not exceed $6,000
         within a period of three consecutive years beginning with the individual’s initial date of enrollment
         on the level one waiver.

PROCEDURE:

    A.       The Financial Oversight Committee will consist of the Business Services Director, the
             Business Services Manager, the Operations Director, the Community Resource Director and
             the Service and Support Administration Director.

    1.       The Financial Oversight Committee will meet weekly or as needed following the
             Administrative Team meeting although the Financial Oversight Committee may approve very
             simple requests without convening a meeting if all committee members agree. The Financial
             Oversight Committee will review:

                all requests for environmental modifications, assistive/adaptive equipment, specialized
                 medical equipment and repairs.
                all requests for prior authorization for services to exceed the ODDP range.
                all individual budgets.
                all acuity change requests.
                all plan changes that exceed $5,000 in cost. This includes but is not limited to any
                 schedule changes or service changes affecting transportation, therapy costs, supported
                 living or waiver changes.

    2.       The Financial Oversight Committee will request that no less than two quotes be obtained
             prior to approval and will provide guidance on requirements for quotes, such as ADA
             accessibility, drawings to accompany quotes, general specifications of quote, permit
             requirements, etc.      The Committee may request additional information, further
             evaluation/assessment,    on    site   reviews,   or    may    recommend     alternative
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     modifications/equipment.        OT/PT recommendations may be required for therapeutic
     equipment and accessibility modifications. Physician recommendation may be required for
     medical equipment. Obtaining a recommendation from an OT/PT/Physician to accompany
     the request is strongly recommended anytime non-traditional equipment is being requested
     or anytime that it is not readily apparent how item(s), services, the requested will directly
     affect the individual’s disability.
3.   If the Financial Oversight Committee denies a request, Medicaid appeal rights will be
     provided to the Individual and their parent/guardian.

B.   An assessment of individual needs will be made by the Service Coordinator prior to initiating
     requests for environmental modifications.

     1. This assessment will include a comprehensive review of environmental accessibility
        needs and equipment needs. These needs will then be prioritized according to health,
        safety, welfare and urgency of need. The Service Coordinator will notify the family and/or
        Individual that they will be asked to obtain a minimum of two quotes prior to approval of
        the modification or equipment but that prior to obtaining the quotes the committee will
        provide some guidance on vendor requirements for quote, for example, ADA
        requirements, permit requirements, etc. Some requests must be approved by the Human
        Rights Committee and/or the Behavior Support Committee prior to approval by the
        Financial Oversight Committee. This is to ensure that Human Rights and Behavior
        Support requirements are met by the Warren County Board of Developmental
        Disabilities.
     2. Families must be informed that no contractors shall be hired to make modifications and
        no equipment shall be ordered prior to committee authorization.
     3. The Service Coordinator will work with the individual and family to develop a plan to
        make requests based upon prioritized needs.
     4. After Committee approval of expense, the Service Coordinator will add all approved
        equipment and modifications to the individuals ISP.

C.   When requesting a modification or equipment, the Service Coordinator must submit to the
     Community Resource Director or the Service and Support Administration Director the
     assessment information and information describing the modification and why it is necessary
     to meet health and safety and how it is of direct benefit to the individual’s specific disability.
     The applicable Director will contact Financial Oversight Committee members to set up a
     meeting or will place the request on the agenda for the next scheduled Financial Oversight
     Committee. In the event that a request represents an urgent health and safety need the
     Committee will respond to the family within three working days, or sooner if possible.

D.   Quotes – The Financial Oversight Committee may provide guidance on quotes such as
     meeting ADA requirements, the necessity of drawings of modifications, requirements for
     permits, etc. All modifications and equipment purchases will require two quotes from different
     vendors showing the cost from each. Approval of items with less than two quotes will need to
     demonstrate attempt on the part of the Service Coordinator to obtain additional quotes and
     vendor denial.

                                           PROCESS

     When a request is being made to the Financial Oversight Committee, the Service Coordinator
     shall detail the request on the “Request for Assistive Equipment and/or Environmental
     Modification, as a Waiver Service, Assessment and Committee Review Form” (CRF-117)
     form, attaching quotes for adaptive equipment requests and any other information pertinent to
     the request and the individual’s needs.
     The Financial Oversight Committee shall review the requests and either approve, deny or
     require additional information regarding the request. An approved request does not
     automatically indicate that the issue is allowable under parameters that the County Board

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            must operate within. For example, when a modification is being requested for a rental
            property, permission must be granted from the landowner prior to changes being made to the
            property. The County Board cannot ensure that properties are returned to “pre-modification”
            condition. There may be other extenuating circumstances that would prevent an approved
            request from being processed. Other examples may be lack of a certified Medicaid provider,
            etc. The Service Coordinator will work with the Financial Oversight Committee and the
            Individual/Family regarding these issues.

Home Modification Procedure #1

When an individual/guardian requires a home modification and desires to pay for that modification by
either a Level One or an Individual Option waiver and;

The individual/guardian desires to incorporate other work related to the overall project but not related to
the modification required due to the waiver recipient’s disability and/ or;

The individual/guardian desires to employ a contractor of their own choosing for whatever reason they
deem appropriate;

The following procedure shall be followed:

            a. The WCBDD will develop a base specification for contractors to quote that clearly states
               the minimum accessibility modifications that are being addressed by the modification and
               solicit quotes from at least 3 qualified contractors
            b. The WCBDD will evaluate the quotes received and designate the lowest (responsive)
               quote as a maximum allowance that the family can apply toward a modification that
               meets the minimum accessibility specification expressed in the base specification,
            c. The individual/guardian may then determine their own design, contractor, pricing etc. as
               long as the project retains the minimum accessibility specification outlined in the base
               specification
            d. The individual/guardian shall submit plans and costs to the Operations Director for review
               prior to proceeding, to confirm that the proposed work meets the minimum accessibility
               specification set by the base specification.        If the plans do not meet the minimum
               accessibility specification, the Committee will notify the individual/ guardian of the
               deficiencies and request a new submittal detailing the conforming alterations
            e. Once it is determined the plans meet the minimum accessibility specification, the
               Committee would notify in writing the individual/guardian and the contractor of the plan
               approval and confirm the dollar amount the contractor will receive from WCBDD upon
               satisfactory completion of the work
            f.  The contractor will have to register as a vendor with WCBDD and provide WCBDD a
               certificate of insurance naming WCBDD as additional insured and a current worker’s
               comp certificate (the same insurance requirements will apply to any subcontractors that
               are used by the contractor) and a P.O. would have to be issued. The contractor shall be
               responsible for obtaining all required permits and approvals before receiving payment
               from WCBDD.
            g. Upon satisfactory completion of the work, on site confirmation by WCBDD that the
               completed work meets minimum accessibility specifications included in the approved
               plan, a copy of the final permit approvals and a final invoice from the contractor, the
               WCBDD shall request and issue a check to the contractor for the amount previously
               agreed to by the Committee and contractor. In the event the cost of the work is less than
               anticipated for any reason, the WCBDD reserves the right to reduce their payment to the
               contractor to an amount that fairly represents the cost of the work attributed to meeting
               the minimum accessibility specification.

If the individual/family does not have a preferred provider, the Operations Director will assist the
individual/guardian in developing a specification for the project. The Operations Director will solicit bids

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and coordinate the modification. Any upgrade not part of the specification will be the responsibility of the
individual/guardian in keeping with health and safety, efficiency, economy and quality of care
requirements of the waiver.

General Limitations and Exceptions

    Walk in Shower note - The size of shower necessary for health and safety will be determined by the
    Operations Director in consultation with the team. In general, maximum size for walk in shower
    modifications is 25 square feet or a 5 x 5 shower.

    Flooring square footage allowance – when upgraded materials are requested, the committee
    reserves the right to provide an allowance, above which the homeowner must pay the remaining
    costs. Waiver services are established to provide efficiency, economy and quality of care. Materials
    not necessary to ensure health and safety may be funded by the homeowner/family over and above
    the flooring allowance. The current allowance is $5 per square foot.

    When other upgraded materials are requested, the Operations Director will work to establish the
    acceptable materials to ensure health and safety. Any cost over this specification will be the
    responsibility of the homeowner/family requesting the modification.

    Fencing – When fencing requests are made, documentation/evidence must be provided from
    caregivers and medical professionals regarding documented issues/problematic issues caused by the
    lack of a fence. A statement from a medical professional addressing the direct medical and remedial
    benefit of a fence to the individual would be appropriate and beneficial. When the team determines
    that a fence is necessary to ensure health and safety of an individual, the maximum fence size shall
    be 200 linear feet with one gate. Additional linear feet or additional gates requested by the
    individual/guardian may be per a separate agreement between the contractor and the
    individual/guardian. The intent of the waiver is to ensure health and safety, a fence in excess of 200
    linear feet is considered an optional upgrade in excess of what is necessary to ensure health and
    safety of the individual being served. Approved fencing materials are split rail with a mesh liner or 4
    foot cedar picket fencing. If the individual/guardian determines that they wish an upgraded material
    (such as wrought iron or vinyl, they will be provided an allowance of the cost of the approved
    materials and may supplement the fencing cost that is over and above the cost of the approved
    fencing materials.

    In all cases individuals/families must be prepared to demonstrate how requests are related to health
    and safety and/or are of specific benefit to the individual’s disability. All equipment requests should
    be for “specialized” equipment, not equipment that is commonly available and commonly used by
    individuals regardless of their ability level.


APPROVED:


                                                                                    11-22-2010
         Megan K. Manuel, Superintendent                                               Date




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                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

ROOMMATE MATCH PROCEDURE                                                                 SECTION 1.26


PURPOSE: It is important that services be shared to manage resources and ensure maximum use of
resources. It is also important that roommate matches are compatible and involve individual choice and
input. This procedure was developed to expedite the selection of roommates, and filling vacancies in
homes.

PROCEDURE:

   A. Warren County Board of Developmental Disabilities will coordinate roommate matches based
      upon available resources.

   B. The Community Resource Director will maintain a list of all openings in waiver group homes,
      Community Housing Assistance Program homes, and homes leased by individuals receiving
      waiver services. Individuals receiving waiver services and those individuals receiving rental
      subsidy from the Board will be strongly encouraged to share housing, unless specific
      circumstances exist which create health and safety concerns if services were shared.

   C. The Service and Support Administration Director and Managers will maintain list of individuals
      enrolled on waivers and needing placement or wishing to find alternative placements, based upon
      their discussion throughout the month with SSAs and Intake Specialists. The Service Coordinator
      or Intake Specialist will present any ideas the individual or Service Coordinator/Intake Specialist
      have as possible roommates and individual’s choice will be first priority. The Service Coordinator
      or Intake Specialist for each individual seeking placement or alternative placement will provide
      the following information to their supervisor regarding this individual;
            Name of individual
            Gender of roommates sought
            Age of individual and age preference, if this is important.
            If the individual needs accessible housing and if so what type of accessibility – i.e.
               wheelchair accessibility, or modifications to address specific disability issues?
            Preferred area/town of placement
            If the individual has a current provider
            Are there UIs or MUIs that should be considered?
            Does the individual have a behavior support plan?

   D. A Roommate Match Committee meets monthly to review current openings and identify possible
      roommate matches. The Roommate Match Committee consists of Community Resource
      Director, Service and Support Administration Director, Service and Support Administration
      Managers, and Quality Assurance Director. Other individuals may be invited to the committee as
      needed.

   E. The Committee will review suggestions for roommates, needs and openings and make
      recommendations about possible matches. The Service and Support Administration Managers
      will work with Service Coordinators to facilitate meetings between possible roommates,
      guardians, providers and visits to homes.

   F. If new housing is being sought, the Community Resource Director and/or Service and Support
      Administration Director will review the housing prior to leases, etc. being entered into for the
      move.


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  G. In emergency situations Community Resource Director and Service and Support Administration
     Director, or other members of the Committee, will discuss the emergency and how immediate the
     need is for placement. Emergency placements are made to ensure health and safety, therefore
     provider choice, roommate choice, and location may not always be possible to address. All
     openings are discussed and the best possible openings are presented to the individual and or
     guardian, or we work with a licensed home to do temporary respite. Other individuals in the
     home and/or guardians will be contacted to discuss the possibility of the individual coming into
     the home to ensure this is acceptable.

  H. The Service Coordinator will complete an ISP Revision prior to the move into a new home and
     Business Services division will modify Payment Authorization for Waiver Services (PAWS) for the
     individual and any affected roommates.

  I.   Transportation and Adult Day Service will be contacted regarding the move.

  J.   If rental subsidy is needed the Community Resource Fiscal Specialist will be provided Rental
       subsidy Request form.




APPROVED:


                                                                   September 20, 2010
        Megan K. Manuel, Superintendent                                          Date




                                      Roommate Match Procedure
                                            Page 2 of 2
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                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

INCIDENTS ADVERSELY AFFECTING HEALTH AND SAFETY                                           SECTION 2.00

PURPOSE:        The Investigative Agent shall investigate and report major unusual incidents (MUI’s) and
shall review and may investigate other unusual incidents. The Investigative Agent will report MUI’s to the
Superintendent and should always follow the Administrative Code 5123:2-17-02 and seek advice and
support from the Quality Assurance Director and/or ODODD to ensure the health and safety of
consumers.

PROCEDURE:

A. DEFINITIONS:

    1.    “ Administrative investigation” means the gathering and analysis of information related to a
          major unusual incident so that appropriate action can be taken to address any harm or risk of
          harm and prevent future occurrences.
    2.    “ Agency provider” means a provider, certified or licensed by the department, that employs staff
          to deliver services to individuals and who may subcontract the delivery of services
    3.    “ At-risk individual” means an individual whose health or safety is adversely affected or whose
          health or safety may reasonably be considered to be in danger of being adversely affected.
    4.    “County Board”, means a county board of developmental disabilities established under Chapter
          5126 of the Revised Code or a regional council of government formed under Chapter 167 of
          the Revised Code when it includes at least one county board.
    5.    ‘County board as a provider” means the county board when acting as the provider to the
          individual who is the subject of the incident.
    6.    “Department” means the Ohio Department of Developmental Disabilities as established by
          section 12.02 of the Revised Code.
    7.    “Developmental Center” means a facility under the managing responsibility of the department.
    8.    “ICF/MR” means an intermediate care facility for the mentally retarded.
    9.    ‘Incident Tracking System (ITS) means the department’s on-line system for reporting major
          unusual incidents.
    10.   “Individual” means a person with mental retardation or other developmental disabilities.
    11.   ‘Individual provider” means a provider certified by the department who is self-employed and not
          an agency and who personally delivers services to individuals and who may not subcontract
          the delivery of services.
    12.   “Investigative agent” means an employee of a count board or a person under contract with a
          county board who is certified by the department to conduct investigations of major unusual
          incidents.
    13.   “Major Unusual Incident” (MUI) means the alleged, suspected, or actual occurrence of an
          incident when there is reason to believe the health or safety of an individual may be adversely
          affected or an individual may be placed at a reasonable risk of harm as listed in this paragraph,
          if such individual is receiving services through the DD service delivery system or will be
          receiving such services as a result of the incident. Major Unusual Incidents include, but are not
          limited to, the following:

          a.   Abuse. “Abuse” means any of the following:

               I.    Physical Abuse. “Physical Abuse” means the use of physical force that can be
                     reasonably expected to result in physical harm or serious physical harm as those
                     terms are defined in Section 2901.01 of the Revised Code. Such force includes, but
                     is not limited to, hitting, slapping, pushing, or throwing objects at an individual.




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     II.    Sexual Abuse. “Sexual Abuse” means unlawful sexual conduct or sexual contact as
            those terms are defined in Section 2907.01 of the Revised Code and the commission
            of any act prohibited by section 2907.09 of the Revised Code (e.g., public indecency,
            importuning and voyeurism).
     III.   Verbal Abuse. “Verbal Abuse” means purposefully using words or gestures to
            threaten, coerce, intimidate, harass, or humiliate an individual.

b.      Attempted suicide. “ Attempted suicide” means a physical attempt by an individual that
        results in emergency room treatment, in-patient observation, or hospital admission
c.      Death. “Death” means the death of an individual.
d.      Exploitation. “Exploitation” means the unlawful or improper act of using an individual or
        an individual’s resources for monetary or personal benefit, profit, or gain.
e.      Failure to report. “failure to report” means that a person, who is required to report
        pursuant to section 5123.61 of the Revised Code, has reason to believe that an individual
        has suffered or faces a substantial risk of suffering any wound, injury, disability or
        condition of such a nature as to reasonably indicate abuse (including misappropriation)
        or neglect of that individual, and such person does not immediately report such
        information to a law enforcement agency, a county board, or, in the case of an individual
        living in a developmental center, either to law enforcement or the department. Pursuant
        to division (C) (1) of section 5123.61 of the Revised Code, such report shall be made to
        the department and the county board when the incidents involves and act or omission of
        an employee of a county board.
f.      Known injury. “Known injury” means an injury from a known cause that is not considered
        abuse or neglect and that requires immobilization, casting, five or more sutures or the
        equivalent, second or third degree burns, dental injuries, or any injury that prohibits the
        individual from participating in routine daily tasks for more than two consecutive days.
g.      Law enforcement. “law enforcement” means any incident that results in the individual
        being charge, incarcerated or arrested.
h.      Medical emergency. “Medical emergency’ means an incident where emergency medical
        intervention is required to save an individual’s life (e.g., Heimlich maneuver,
        cardiopulmonary resuscitation, intravenous for dehydration).
i.      Misappropriation.      “Misappropriation” means depriving, defrauding, or otherwise
        obtaining the real or personal property of an individual by any means prohibited by the
        Ohio Revised Code, including Chapters 2911 and 2913 of the Revised Code.
j.      Missing individual. “Missing individual” means an incident that is not considered neglect
        and the individual cannot be located for a period of time longer than specified in the
        individual service plan and the individual can not be located after actions specified in the
        individual service plan are taken and the individual cannot be located in a search of the
        immediate surrounding area; or circumstances indicate that the individual may be in
        some immediate jeopardy; or law enforcement has been called to assist in the search for
        the individual.
k.      Neglect. “Neglect means when there is a duty to do so, failing to provide and individual
        with any treatment, care, goods, supervision, or services necessary to maintain the
        health or safety of the individual.
l.      Peer-to-peer acts. “Peer-to-peer acts” means acts committed by one individual against
        another when there is physical abuse with intent to harm; verbal abuse with intent to
        intimidate, harass, or humiliate; any sexual abuse; any exploitation; or intentional
        misappropriation of property of significant value.
m.      Prohibited sexual relations. “Prohibited sexual relations” means an DD employee
        engaging in consensual sexual conduct or having consensual sexual contact with an
        individual who is not the employee’s spouse, and for whom the DD employee was
        employed or under contract to provide care at the time of the incident and includes
        persons in the employee’s supervisory chain of command.
n.      Rights code violation. “rights code violation” means any violation of the rights
        enumerated in section 5123.62 of the Revised Code that creates a reasonable risk of
        harm to the health or safety of an individual.

                       Incidents Adversely Affecting Health and Safety
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            o.       Unapproved behavior support. “Unapproved behavior support” means the use of and
                     aversive strategy or intervention implemented without approval by the human rights
                     committee or behavior support committee or without informed consent.
            p.       Unknown injury. “Unknown injury” means an injury of an unknown cause that is not
                     considered possible abuse or neglect and that requires treatment that only a physician,
                     physician’s assistant, or nurse practitioner can provide.
            q.       Unscheduled hospitalization,       “Unscheduled hospitalization” means any hospital
                     admission that is not scheduled unless the hospital admission is due to a condition that is
                     specified in the individual service plan or nursing care plan indication the specific
                     symptoms and criteria that require hospitalization.

     14. “DD employee” means any of the following:

            a.       An employee of the department
            b.       An employee of a county board
            c.       An employee in a position that includes providing specialized services to an individual

     15. “Primary person involved” (PPI) means the person alleged to have committed or to have been
         responsible for the abuse, exploitation, failure to report, misappropriation, neglect, prohibited
         sexual relations, rights code violation, or suspicious or accidental death.
     16. “Provider” means any person or entity that provides specialized services and that is subject to
         certification, licensure, or regulation by the department regardless of source of payment.
         “Provider” includes a county board providing services and a county board contracting entity as
         defined in section 5126.281 of the Revised Code when providing specialized services.
     17. “Specialized services” means any program or service designed and operated to serve primarily
         individuals, including a program or service provided by an entity licensed or certified by the
         department.
     18. “Unusual incident” (UI) means an event or occurrence involving an individual that is not
         consistent with routine operations, policies and procedures, or the care or individual service plan
         of the individual, but is not an MUI. Unusual incidents (UIs) include, but are not limited to,
         medication errors; falls; peer-to-peer incidents that are not MUIs; overnight relocation of a n
         individual due to fire, natural disaster, or mechanical failure; and any injury to an individual that
         is not an MUI.
     19. “Working Day” means Monday, Tuesday, Wednesday, Thursday, or Friday, except when that
         day is a holiday as defined in Section 1.14 of the Revised Code.

B.     REPORTING:

       1.         All incidents (MUI/UI) shall be reported to the Board Investigative Agent immediately, but no
                 later than 4 hours of occurrence and/or initial knowledge. The telephone number for the
                 Investigative Agents are (513) 695-1840 and (513) 695-1842. The fax number for reporting
                 incidents is (513) 695-2425. The agency 24-hour emergency phone number is 1-800-
                 800-6847.
       2.         Local law enforcement and/or Children’s services shall be notified of all possible abuse,
                 misappropriation or neglect
       3.        The reporting staff, if necessary, will seek immediate and ongoing medical attention for the
                 individual.
       4.        Notification can be made verbally or written. If notification is initially done verbally, written
                 documentation must follow no later than 12:00 p.m. the next working day.
       5.         Board employees will document all MUI/UI incident information by filling out agency form(s);
                 Unusual Incident Form AGF-012, Behavior Incident Form AGF-028 and Illness/Accident
                 form AGF-032. The Unusual Incident form and Behavior Incident form will then be faxed
                 immediately to the Quality Assurance Division at (513) 695-2425.                   The original
                 Illness/Accident Form AGF-032 will be sent to the nursing department to be logged/reviewed.
       6.        The nursing department will submit the Illness/Accident form AGF-032 to the division
                 director/designee.

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     7.    Board employees will turn the original completed Unusual Incident form AGF-012 and
           Behavior Incident form AGF –28, into their division director/designee.
     8.    The division director/designee will review and sign all incident forms and ensure that the
           parent/guardian/advocate/SSA/residential facility was notified (by whom and what time), and
           then sends the form to the Investigative Agent(s).
     9.    All licensed or certified service providers including components of the Warren County Board
           of Developmental Disabilities shall report all alleged suspected, or actual major unusual
           incidents to the Warren County Board of Developmental Disabilities immediately, but no
           later than four (4) hours , following the service provider’s or Board’s initial knowledge of the
           occurrence of an alleged, suspected, or actual major unusual incident and shall submit a
           written report to the Board by 12:00 p.m. the next working day. The Investigative Agent(s)
           shall receive all reports.
     10.   If the incident is determined to be a Major Unusual Incident it will be reported     to ODODD
           through the Incident Tracking System (ITS) on the Internet or via fax.
     11.   Incident reports may be provided to parties authorized to receive them in accordance with
           sections 5123.613 & 5126.044 of the Ohio Revised Code.

C.   INVESTIGATION:

     1.     The Superintendent, Investigative Agent(s)and Quality Assurance Director will be notified of
            all MUI’s.
     2.     Determination of whether an incident is an MUI will be made by the Investigative Agent(s)
            based on Administrative Code Section 5126:2-17-02.
     3.     Upon determination that an MUI has occurred, the Investigative Agent(s) will complete the
            initial incident report. Initial reports will be transmitted to ODODD via the Incident Tracking
            System (ITS) on the Internet.
     4.     Investigations shall be initiated immediately or within twenty-four hours of notification.
     5.     If an MUI occurs in the evening or on a day that WCBDD is closed, the report will be made to
            ODODD by 3:00 pm the following work day.
     6.     The Investigative Agent(s) will report all incidents of abuse, neglect, and misappropriation
            involving adults to law enforcement.
     7.     All incidents of abuse, neglect, or misappropriation involving individuals’ age birth to 21 years
            of age will be reported to Children’s Services.
     8.     If the Investigative Agent(s) becomes aware of a report already filed with law enforcement or
            Children’s Services then an MUI report should be completed.
     9.     MUI’s occurring in an ODODD licensed facility, which might result in           licensure citations
            must be reported to ODODD. As per licensure rule, in cases of abuse, neglect or
            misappropriation, the suspected perpetrator must be removed from client contact until the
            investigation is completed.
     10.    Investigative Agent(s) will work cooperatively with these agencies (law              enforcement,
            Children’s Services, and ODODD licensure) to assist in the investigation.
     11.   If no investigation is undertaken by these agencies, the Investigative Agent(s) will conduct the
            investigation.
     12.    While conducting an investigation, the Investigative Agent(s) shall follow           the ODODD
            prescribed protocol(s).
     13.     At the conclusion of the investigation the Investigative Agent(s) must be prepared to make a
            determination of whether the incident is substantiated.
     14.    Recommendations should be made to correct the situation and prevent further occurrences,
            if appropriate.
     15.    The individual’s parent, if a minor, SSA, advocate selected by the individual, residential
            provider, court appointed guardian and/or caregiver of the individual will be notified of the
            incident on the same day as the incident (unless the one of the aforementioned people is the
            PPI, the spouse of or significant other of the PPI). The notification will include the immediate
            action taken to ensure the health & safety of the person.




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    16.     Written summaries of the incident investigation (including recommendations and conclusions)
            will be sent to the individual, guardians, parents of minor children, or other agencies
            authorized to receive information (e.g. Children’s Services, Law Enforcement, etc.) five days
            after to the incident being finalized with the ODODD. Requests for incident summaries must
            be made through the Quality Assurance Division.
    17.     If the incident occurred at a program site of Warren County DD, the Investigative Agent(s) will
            submit copies of the incident summary to the appropriate Division Director and to the
            Superintendent, within five days of the conclusion of the investigation.
    18.     For alleged incidents of abuse and neglect occurring at Warren County DD program sites, the
            Division Director whose subordinate is being investigated for possible abuse, neglect or
            misappropriation must remove that person from contact with persons served for the duration
            of the investigation or subsequent corrective action proceedings.
    19.     The MUI Investigation and any conclusions and recommendations made shall remain
            separate and independent of any other investigation or review done in the process of
            disciplinary action.
    20.      If the incident occurred in a residential setting, a written incident summary will be given to the
            Director of the facility or the designated staff to receive such reports.
    21.      For alleged incidents of abuse, neglect or misappropriation occurring in residential settings
            licensed by ODODD or contracted by WCBDD the Investigative Agent(s) will recommend that
            this staff person be removed from contact with residents for the duration of the investigation.
            The residential agency should follow it’s own policies and licensure standards to ensure the
            residents’ protection.
    22.     All MUI’s will be reported to ODODD via the Incident Tracking System on the Internet or via
            fax. All MUI/UI Reports will include at a minimum:

               Clear statement of allegation.
               Summation of investigative efforts and events (who, what, when, where, why and how.)
               Chronology of events that lead to the discovery of the incident, the actions taken to
                ensure health and safety (immediate actions), the monitoring of the individual, the
                investigation events, the prevention steps implemented, evidence collection (supporting
                documents, interviews, etc…) and the disposition based on supporting documentation of
                findings.
               Summary of credibility issues of persons interviewed.
               Trends/patterns (existing or potential.)
               Summary of facts and how they support findings. Protection from harm efforts including
                monitoring and prevention to ensure health and safety.

    23.      Written summaries shall not be provided to the PPI, the PPI’s spouse or the PPI’s significant
            other. No later than five working days following the closure of a case, the Investigative
            Agents(s) shall make a reasonable attempt to notify the PPI as to whether the MUI has been
            substantiated, unsubstantiated/insufficient evidence, or unsubstantiated/unfounded.

    24.     All incident reports will be maintained in a locked file cabinet in the Quality Assurance
            Division.

    25.     All WCBDD staff members and contracted staff shall abide by the agency policy regarding
            Confidentiality.


APPROVED:


                                                                                   March 26, 2010
          Megan K. Manuel, Superintendent                                              Date




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                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

UNUSUAL INCIDENTS DEFINITION AND REPORTING                                                  SECTION 2.01

PURPOSE:        To ensure all Unusual Incidents are reported and reviewed in a timely manner and
monitored for any trends and/or patterns.

PROCEDURE:

DEFINITION:

“Unusual incident” (UI) means an event or occurrence involving an individual that is not consistent with
routine operations, policies and procedures, or the care or individual service plan of the individual, but is
not an MUI. Unusual incidents (UIs) include, but are not limited to, medication errors; falls; peer-to-peer
incidents that are not MUIs; overnight relocation of a n individual due to fire, natural disaster, or
mechanical failure; and any injury to an individual that is not an MUI.

TYPES OF UNUSUAL INCIDENTS:

A. Unusual Incident: an event or occurrence that is not consistent with routine day-to-day operations,
   policies, procedures or the care of an individual or their activities.

B. Accident/Illness: an accident involving or the illness of an individual.

C. Behavior Incident: an incident in which the individual exhibited a behavioral episode/concern.

REPORTING, FOLLOW UP AND REVIEW:

A. All Unusual Incidents should be reported immediately, but no later than 4 hours after the incident.
   Unusual Incidents reported on the Unusual Incident Form, Illness/Accidents reported on the
   Participant Illness/Accident form, and Behavior Incidents reported on the Unusual Behavior Incident
   form.

B. If the UI occurs at a site operated by the county board or at a site operated by an entity with which the
   county board contracts, the county board or contract entity shall notify the licensed provider or staff or
   family, as applicable at the individual’s home. The notification shall be made the same day that the
   incident is discovered.

C. Individual/independent providers shall make reports to the Provider Compliance Specialist/designee
   on the day the UI is discovered. The Provider Compliance Specialist/designee shall be responsible
   for logging these incidents.

PROCESS:

A. The reporting division will be responsible for notifying the individual’s parent/guardian, SSA, advocate
   selected by the individual and/or the residential provider the same day that the incident is discovered.
   The reporting division will indicate the date/time of notification on the form.

B. The Investigative Agent/designee will ensure that the appropriate actions have been taken to protect
   the health and safety of the individual(s).

C. An incident response form (Unusual Incidents on AGF-109, Accident/Illness Incidents on AGF-86,
   and Behavior Incidents on AGF-119) will be sent back to the staff member responsible for completing
   the follow up regarding the incident. The follow up form should be completed, then reviewed and


                                  Unusual Incidents Definitions and Reporting
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   signed by the Division Director. The Division Secretary should then send a copy to the
   individual/guardian/residential provider and the original returned to the Quality Assurance division to
   be filed.

D. The Investigative Agent(s), Provider Compliance Specialist and QA Director shall review, on a
   monthly basis a representative sampling of provider logs, individual provider log(s) and logs where
   the county board is a provider for the purpose of ensuring that all MUIs required to be reported have
   been reported and that trends and patterns have been identified and addressed. The sampling shall
   be made available to the department for review upon request.

E. All agency providers, and the County Board as a provider, shall ensure that trends and patterns of
   UIs are included and addressed in each individual’s service plan.

F. The ISP will be amended by the SSA Division within 30 days of the recommendation.



APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




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                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INVESTIGATING MAJOR UNUSUAL INCIDENTS                                                       SECTION 2.02

PURPOSE:          To ensure that all reported Major Unusual Incidents are investigated according to the
protocol set forth in the Ohio Administrative Code 5123:2-17-02

PROCEDURE:

A. THE INVESTIGATION CONSISTS OF FOUR BASIC STEPS:

   1.   Planning the Investigation,
   2.   Gathering Information,
   3.   Analysis of Information, and
   4.   Completion of an Investigation Report

B. THE INVESTIGATIVE AGENT SHOULD TAKE THE FOLLOWI NG STEPS IN CONDUCTING AN
   INVESTIGATION:

   1. Initiate the investigation (see Steps 2-9) within 24hours of the time the report was filed. Some
      cases require immediate investigation. The administrative investigation should not interfere with
      the criminal investigation. Incidents that are referred to law enforcement and a criminal
      investigation is ongoing, there should be follow-up (see Step 4).

        a. Secure all physical evidence; take photographs of injuries (as needed) and
           secure/sketch/photograph the scene of the incident. When photographing an individual’s
           injury, it would be helpful to have some identification contained within the photograph to show
           the size of the injury (i.e. a coin, ruler, etc). The photograph should be labeled with date/time,
           name of individual, name of photographer and the body part being photographed.

        b. Visit the scene of the incident as soon as possible (if applicable).

        c.   Follow-up with law enforcement, CSB, if needed.

        d. Review all relevant documents relating to the primary person involved that forms the basis for
           the reported incident and the alleged victim.

        e. Interview all direct witnesses to the incident, including the individual. Document the
           interviews. Obtain written statements from each person interviewed during the investigation.

        f.   Interview medical professionals (as needed) as to the possible cause or age of injuries.
             Document the interviews.

        g. Interview others who may have relevant information – service and support administrators,
           program directors, medical personnel who treated the injured individual. Document the
           interviews.

        h. Gather written statements from all relevant witnesses.

        i.   Conduct follow-up interviews, if needed.




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        j.   Complete an investigation report which includes the following:


             1. Clear statement of the allegation and the basic questions(s) to be answered by the
                 investigation,
             2. List all documents reviewed,
             3. Contain a chronology of the investigation,
             4. Witness statements,
             5. Evaluation of all witnesses and documentary evidence in a clear, complete and non-
                 ambiguous manner,
             6. Summary of witness statements,
             7. Evaluation of the relative credibility of the witnesses,
             8. Summary of evidence,
             9. A succinct and well-reasoned analysis of the evidence, and
             10. A clearly stated conclusion, which identifies which allegations were and were not
                 substantiated.
             11. The investigation report should not include any confidential information (see
                 Administrative Code 5123:2-17-02 Paragraph (J)(2).
             12. The investigation will be completed within thirty (30) days of initiation




APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                                Investigating Major Unusual Incidents
                                              Page 2 of 2
                                                                                                     Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

MUI/UI INVESTIGATIONS INVOLVING WARREN COUNTY BOARD                                             SECTION 2.03
EMPLOYEES AND OTHER SPECIFIED INDIVIDUALS

PURPOSE:         To ensure all alleged MUI/UI incidents involving Warren County Board employees and
other specified individuals are investigated fairly and in a uniform manner ensuring a timely conclusion to
the incident.

PROCEDURE:

All Major Unusual Incident/Unusual Incidents under investigation shall not be discussed with other
Warren County Board of DD staff members, as confidentiality of information is paramount.

In the event a Warren County Board of DD employee is reported to be involved in an alleged MUI or UI,
the following procedures will occur:

A. MAJOR UNUSUAL INCIDENTS INVOLVING WCBDD EMPLOYEES:

    1. The Investigative Agent will notify the division director that the staff involved in the investigation
       should be removed from client/student contact and placed on paid administrative leave until the
       issue is resolved.

    2. The Investigative Agent will follow the investigation protocol as outlined in ODODD Administrative
       Code 5126:2-17-02.

    3. If the incident is found to be unsubstantiated, the employee will be told so and asked to return to
       work and follow any recommendations made by the Investigative Agent, if applicable.

    4. If the incident is found to be substantiated, the division director will follow the agency
       policies/procedures for disciplinary actions, if necessary.

B. UNUSUAL INCIDENTS INVOLVING WCBDD EMPLOYEES:

    1. The Investigative Agent receives a report regarding an employee involved in an alleged Unusual
       Incident; the Investigative Agent will make a recommendation to the division director.

    2. This recommendation may be to put the staff member on administrative leave with pay until the
       issue is resolved and/or to complete an administrative investigation regarding the concern.

    3. If the allegation is found to be true, the division director should follow agency policy/procedure
       regarding disciplinary action, if necessary.

    4. Regardless of the outcome, the division director should send a summary report to the
       Investigative Agent that outlines the findings and/or disciplinary actions taken.

    5. This action should be completed no later than 30 days after the initial report so that the case can
       be closed.

C. THE INVESTIGATIVE AGENT WILL CONTACT THE OHIO DEPARTMENT OF DD AND REQUEST
   A SEPARATE REVIEW AND/OR INVESTIGATION IF THE ALLEGED INCI DENT INCLUDES AN
   ALLEGATION AGAINST:

    1. The superintendent


                MUI/UI Investigation Involving WCBDD Employee and Other Specified Individuals
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     2. A management employee who reports directly to the superintendent

     3. An investigative agent

     4. A Service Coordinator (SSA)

     5. A Board member

     6. A person having any known relationship with any of the persons specified identified above or as
        listed in paragraphs (I) (1) (a) to (I) (1) (g) of the administrative rule 5123:2-17-02 when such
        relationship may present a conflict of interest or the appearance of a conflict of interest.

     7. An employee of the Board when it is alleged that the employee is responsible for an individual’s
        death, has committed sexual abuse, engaged in prohibited sexual activity, or committed physical
        abuse or neglect resulting in emergency room treatment or hospitalization.

D.       A department-directed investigation or investigation review may be conducted following the
         receipt of a request from the Board, developmental center, provider, individual or guardian if the
         department determines that there is a reasonable basis for the request.

E.       The department may conduct a review or investigation of any MUI or may request that a review or
         investigation be conducted by another county board, regional council of government or any other
         governmental entity authorized to conduct an investigation.



APPROVED:


                                                                                    March 26, 2010
          Megan K. Manuel, Superintendent                                               Date




                 MUI/UI Investigation Involving WCBDD Employee and Other Specified Individuals
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                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

MUI RECOMMENDATION FOLLOW UP REPORTS                                                      SECTION 2.04



PURPOSE:         To ensure that recommendations made upon completion of Major Unusual Incident
reports are followed up or that alternative solutions have been put in place to ensure the best practice
and health, safety, and welfare of those served.

PROCEDURE:

A.      Upon conclusion of investigations, reports are completed and recommendations are made to
        individuals responsible for addressing these issues.

B.     Reports are routed to the Quality Assurance Director for review, approval and signature. The
       Investigative Agent(s) logs these incidents onto tracking sheet.

C.     The original form will be filed in the Quality Assurance Division.

D.     A copy of the MUI recommendation will be sent to: the individual, parent/guardian, residential
       provider, SSA Director, SSA and other applicable parties.

E.     In cases where the Investigative Agent suggests follow up in regard to the recommendations; the
       SSA Director/Service Coordinator shall ensure the recommendations are followed and then
       complete a follow up report. If the individual resides in an ICFMR, the follow up recommendations
       will be sent to the Director/QMRP at the ICFMR.

F.      Recommended ISP amendments will be completed by the SSA Division within 30 days.

G.     The follow up report is given to the SSA Director/Asst Director for review, approval and signature.
       The follow up report is then sent to the Investigative Agent(s) and logged. This follow up report is
       put in the individuals MUI file.


APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




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                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

AGENCY INCIDENT REVIEWS                                                                     SECTION 2.05


PURPOSE:
To ensure that all Major Unusual Incidents and Unusual Incidents are reviewed in a timely manner and
monitored for any trends and/or patterns.

PROCEDURE:
In addition to Major Unusual Incidents, the Warren County Board of DD has divided all Unusual Incidents
into three specific categories, Unusual Incidents, Accident/Illness Incidents and Behavior Incidents.

All Major Unusual Incidents and Unusual Incidents should be reported no later than four (4) hours after
the occurrence of the incident. All Major Unusual Incidents and Unusual Incident reports will be
maintained in the Quality Assurance Division.

Major Unusual Incidents and Unusual Incidents should be completed on agency form # AGF-012 and
sent via fax to the Investigative Agent(s) of the Quality Assurance Division at (513) 695-2425. The original
form should then be given to the Division Director for review and signature. The Division Director should
then send the original form to the Investigative Agent(s) at the Quality Assurance Division. The
Investigative Agent/designee will then review the incident, attach a follow up response form and sent it to
the appropriate staff for review, a follow up response and signature. The Division Director will then review
the follow up response, approve it, and send the original forms to the Quality Assurance Division.


Illness/Accident Incidents should be completed on agency form # AGF-032 and sent via fax to the
Investigative Agent(s) of the Quality Assurance Division at (513-695-2425). The original form should then
be given to the Agency R.N./designee. The R.N/designee will then review the incident, attach a follow up
response form and send it to the appropriate staff for review, a follow up response and signature. The
Division Director will then review the follow up response, approve it, and send the original forms to the
Quality Assurance Division.

Behavior Incidents should be completed on agency form # AGF-028 and sent via fax to the Investigative
Agent(s) at the Quality Assurance Division at (513) 695-2425. The original form should then be given to
the Division Director/Designee. The Division Director/Designee should review the incident, sign the form
and send it to the Investigative Agent(s) at the Quality Assurance Division. The Behavior
Specialist/designee will then review the incident, attach a follow up response form and sent it to the
appropriate staff for review, a follow up response and signature. The Division Director will then review the
follow up response, approve it, and send the original forms to the Quality Assurance Division.

                                   Major Unusual Incident Reviews:

1.      Warren County Board of DD        (WCBDD) will review and analyze major unusual incidents to
        identify patterns and trends.

2.      WCBDD will prepare a monthly report using information contained on the online system
        established by the department for each provider in the county. The report shall identify the
        number and types of incidents that have occurred.

3.      WCBDD will send a report to the provider if any patterns and trends were identified and a
        recommendation to take appropriate action as needed. Upon request by the WCBDD or the
        department, the provider shall provide evidence that this review has been conducted and that
        appropriate action has been taken.


                                          Agency Incident Reviews
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4.    WCBDD will conduct an semi-annual review and analyze the data for the year to identify patterns
      and trends and take corrective action where needed.

5.    WCBDD will ensure that each provider has completed a thorough analysis and corrective
      measures have been implemented to address concerns raised through the analyses.

6.    WCBDD will ensure that patterns and trends of Major Unusual Incidents and/or Unusual Incidents
      are included and addressed in the individual’s plan.

7.    The SSA Division will be responsible for amendments to the ISP suggested as a result of any
      trend/patterns.

                                     Unusual Incident Reviews:

1.    The Unusual Incident Review Committee will be made up of at least two (2) of the following
      WCBDD staff: The Investigative Agent, The Quality Assurance Specialist, the Quality Assurance
      Director.

2.    All Unusual Incidents will be reported within four (4) hours of occurrence on form # AGF-012.

3.    The Investigative Agent will review all reported Unusual Incidents daily to determine whether or
      not they meet the definitional requirements of an MUI set forth in 5123:2-17-02. If the incident is
      deemed an MUI, the Investigative Agent will begin the MUI process. If the incident remains an
      Unusual Incident (UI), the following process will occur:

4.    The Investigative Agent will ensure that the appropriate actions have been taken to protect the
      health and safety of the individual


5.    The Investigative Agent(s) will log each incident in the Unusual Incident Log.

6.    The Quality Assurance Secretary will file the Unusual Incident Form and the Unusual Incident
      Response form in the individuals file in the Quality Assurance Division.

7.    The Unusual Incident Review Committee will review the Unusual Incident Log monthly.

8.    Any trends and/or patterns will be identified. If a trend and/or pattern is discovered, the
      Committee will complete an Unusual Response Form with a recommendation as to how the
      issue(s) might be addressed.

9.    The Response form will be sent to the Service & Support Administration Division so that the
      Service Coordinator can address the trend/pattern in the individuals plan, ensuring that corrective
      measures are developed and followed within 30 days of the recommendation.

10.   Providers will be sent a notification to submit their monthly UI logs to the Unusual Incident Review
      Committee. A log will be kept indicating receipt of these logs and then they will be filed in the
      Quality Assurance Provider Files. A letter from the committee will be sent indicating the log has
      been reviewed and that the committee finds no trends/patterns. If there are concerns identified
      by the committee, those issues will be indicated in the letter with a request that the provider
      respond by the indicated date. A second reminder will be sent if the Provider does not submit
      their log. This log will be provided to the ODDD MUI Unit if requested.

                                 Accident/Illness Incident Reviews




                                        Agency Incident Reviews
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1.       The Accident/Illness Incident Reviews will be completed by the agency Safety Committee made
         up of at least two (2) of the following WCBDD staff: The Investigative Agent, The Adult Services
         Division R.N/designee the Operations Director or any other members of the agency Safety
         Committee.

2.       All Accident/Illness incidents will be reported within 4 hours of the occurrence on form # AGF-032.
         The original form should be sent to the Adult Services R.N./designee and a copy faxed to the
         Quality Assurance Division.

3.       The Adult Services Division R.N/designee/division designee will review all reported
         Accident/Illness reports from all divisions daily to determine whether or not they meet the
         definitional requirements of an MUI set forth in 5123:2-17-02. If the incident qualifies as a Major
         Unusual Incident (MUI), the information will be given immediately to the Investigative Agent to
         begin the MUI process. If the Accident/Illness remains an Accident/Illness Incident, the following
         process will occur:

4.       The Division R.N./designee will complete an Unusual Incident Response Form (#AGF-086). The
         original Accident/Illness Incident Report and the original Unusual Response Form will be sent to
         the Quality Assurance Division. The appropriate Division Secretary will send a copy of the
         response form:

        Individual/Guardian
        Individual the Response Form is addressed to
        Home/Residential Provider
        SSA

5.       The Division R.N./designee will log each incident in the Unusual Incident Log.

6.       The Quality Assurance Division Secretary will file the Accident/Illness Incident Form and the
         Unusual Response Form in the individuals file in the Quality Assurance Division.

7.       The Accident/Illness Incident Review (Safety) Committee will review the Unusual Incident Log
         monthly.

8.       Any trends and/or patterns will be identified. If a trend and/or pattern is discovered, the
         Committee will complete an Unusual Response Form with a recommendation as to how the
         issue(s) might be addressed.

9.       The response form will be sent to the Service & Support Administration Division so that the
         Service Coordinator can address the trend/pattern in the individuals plan, ensuring that corrective
         measures are developed and followed within 30 days of the recommendation..

                                        Behavior Incident Reviews

1.       The Behavior Support Committee will be made up of at least two (2) of the following WCBDD
         staff: The Investigative Agent, The Behavior Specialist, The Behavior Support Committee
         Chairperson.

2.       All Behavior Incidents that occur will be reported within 4 hours of the occurrence on form # AGF-
         028.

3.       All Behavior Incident reports initially will be sent to the Investigative Agent, to determine whether
         or not the incident meets the definitional requirements of an MUI set forth in 5123:2-17-02. If the
         incident qualifies as a Major Unusual Incident (MUI), the information will be filed immediately by
         the Investigative Agent and will begin the MUI process. If the Behavior Incident remains a
         Behavior Incident, the following process will occur:

                                           Agency Incident Reviews
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4.       The report will be given to the Behavior Specialist to log and then complete the Response Form
         (#AGF-086). The original Behavior Incident Report and the Original Unusual Response Form will
         be filed in the Quality Assurance files and a copy will be sent to the appropriate division/staff
         member for follow up. The follow up will then be sent back to the Behavior Specialist and a copy
         will be sent out, by the appropriate Division Secretary, to the following people:

        Individual/Guardian
        Individual the Response form is addressed to
        Home/Residential Provider
        SSA

5.       The Quality Assurance Secretary will file the Behavior Incident Form and the Unusual Response
         Form in the individuals file in the Quality Assurance Division.

6.       The Behavior Support Review Committee, together with the Investigative Agent will review the
         Behavior Incident Log monthly.

7.       Any trends and/or patterns will be identified. If a trend and/or pattern is discovered, the
         Committee will complete an Unusual Response Form with a recommendation as to how the
         issue(s) might be addressed.

8.       The Response form will be sent to the Service & Support Administration Division so that the
         Service Coordinator can address the trend/pattern in the individuals plan, ensuring that corrective
         measures are developed and followed within 30 days of the recommendation.


APPROVED:


                                                                                  March 26, 2010
          Megan K. Manuel, Superintendent                                             Date




                                          Agency Incident Reviews
                                               Page 4 of 4
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

ANALYSIS/REVIEW OF MAJOR UNUSUAL INCIDENTS                                                 SECTION 2.06
AND UNUSUAL INCIDENTS

PURPOSE:         To ensure that all Incidents are reviewed in a timely manner and monitored for any trends
and/or patterns.

A.        UNUSUAL INCIDENTS:

     1.     The UI Incident Review Committee, consisting of the Investigative Agent(s), Quality
            Assurance Specialist, Provider Compliance Specialist, and Director of Quality Assurance (a
            minimum of two of the above mentioned staff members) shall on a monthly basis review, a
            representative sample of the log(s) maintained by each provider (Individual Providers,
            Residential Providers Day Hab Providers and County Board programs when a service
            provider) to ensure that patterns and trends have been identified and to ensure that
            corrective actions have been taken.

     2.     All identified unusual incident trends and/or patterns will be given to the Service Coordinator
            (SSA) to include and address in the individual’s service plan within 30 days of the
            recommendation.

B.        MAJOR UNUSUAL INCIDENTS:

     1.      A committee consisting of the Investigative Agent(s), Quality Assurance Specialist, Provider
             Compliance Specialist, and Director of Quality Assurance (a minimum of two of the above
             mentioned staff members) shall analyze MUIs to identify trends and patterns semi-annually
                     st              st
             (July 31 and January 31 respectively) with the annual review being comprehensive for the
             year.

     2.      The committee shall conduct the analysis and follow-up for all entities operated by the Board
             (Workshop, Transportation, Independent Providers, etc) and send its analysis to the
             department by August 31st for the semi-annual review and by February 28th for the annual
             review.

     3.      Each agency provider shall send its analysis and follow-up for all entities operated by the
             Board (Workshop, Transportation, etc) and send its analysis to the department by August
             31st for the semi-annual review and by February 28th for the annual review.

     4.      The MUI Incident Review Committee (Incident Review Committee should be made up of
             the following County Board Staff: Investigative Agent(s), Provider Compliance Specialist and
             the Director of Quality Assurance, and other stakeholders such as: a residential provider,
             parent of an enrolled individual, and an individual enrolled in one of the County Board’s
             services.)

     5.      The committee shall meet, and minutes shall be maintained and distributed to the committee
             members. Each September, the committee shall convene to review and analyze data for the
             first six (6) months of the calendar year and each March to review and analyze data for the
             preceding calendar year.

     6.      All identified major unusual incident trends and/or patterns will be given to the Service
             Coordinator (SSA) to include and address in the individual’s service plan.




                           Analysis Review of Major Unusual and Unusual Incidents
                                                Page 1 of 2
                                                                                               Effective 03/10




APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                     Analysis Review of Major Unusual and Unusual Incidents
                                          Page 2 of 2
                                                                                                     Effective 03/10




                      WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                     AGENCY PROCEDURE

QUALITY ASSURANCE REVIEWS                                                                         SECTION 2.07


PURPOSE:         The purpose of these guidelines is to ensure that the individual plan is the direct result of the
individual’s personal preferences, choices and desires, that the plan is implemented correctly, revised per the
individual’s request, reviewed by the individual and team members at least annually, and that a quality
assurance review is conducted at least once every three years.

PROCEDURE:

A.   The Quality Assurance process shall be used to determine that the assistance and support required by
     individuals receiving supported living, IO, Level 1 or Martin waivers continues to promote services, supports
     and activities that will provide a valued lifestyle for the individual. The Quality Assurance Review will be
     conducted with consent of the individual/guardian. Quality Assurance will be a continuous process. The
     following Quality Indicators will be considered in each review:

     1.      Choices and Options
     2.      Personal Income
     3.      Housing
     4.      Community Membership
     5.      Personal Satisfaction/Family Satisfaction
     6.      Health
     7.      Safety
     8.      ISP/Service Monitoring

B.   THE QUALITY ASSURANCE REVIEWS MAY INCLUDE BUT ARE NOT LIMITED TO:

     1.      A review of the services that the individual is receiving.
     2.      A review of the individuals’ health and safety.
     3.      A review of all incident reports. All incident report summaries are reviewed and supports are
             identified and implemented to address the nature of the unusual incident. The Investigative
             Agent(s) are consulted with to discuss any pertinent issues.
     4.      Random/informal visits to the individual’s home or day programming placement.
     5.      A review of the individual’s plan to ensure that the services furnished are consistent with the
             identified needs of the individual.
     6.      Day program and/or Adult Services review.

C.   Quality Assurance Reviews shall be conducted by the Qualit y Assurance Specialist or Prov ider
     Compliance Specialist/Designee. Each year the county board shall select a representative sample of all
     individuals receiving supported living, IO, Level 1 and Martin waiver services from the county board. All
     individuals receiving these services in the county shall be reviewed at a minimum of once every three
     years. These reviews will be completed according to the QA Tracking log. All individual requests for a
     Quality Assurance Review will be honored.

          The review shall consist of an interview with the individual, parent or guardian, at least one of the
          service providers, and anyone else that the individual/guardian desires to participate in the review.
          The individual may request that an advocate be present at her/his interview. Otherwise, interviews
          should be conducted individually. The Quality Assurance Specialist or Provider Compliance
          Specialist/Designee will complete a Quality Assurance Assessment Form. The interviews and
          assessment form shall include information regarding the following issues:



                                            Quality Assurance Reviews
                                                    Page 1 of 3
                                                                                                         Effective 12/07




           1.     The individual's involvement with the development of and consent to the services as reflected
                  on the individual’s plan;
           2.     The level of satisfaction with services received;
           3.     The receipt of services/supports as identified on the individual’s plan;
           4.     The individual's satisfaction in the areas of increasing skills (vocational and personal), living
                  more independently in the community, accessing community services, increasing feelings of
                  self-worth and making choices;
           5.     The individual’s desire to modify services identified on his/her plan or to include additional
                  services;
           6.     Review the relationship between the needs and choices expressed by the individual and the
                  services reflected in his/her plan;
           7.     The individual’s satisfaction in the area of day programming;

D.   WARREN COUNTY BOARD OF DD SHALL CONDUCT TWO TYPES OF QU ALITY ASSURANCE
     REVIEWS

     1.    FULL REVIEWS:

           a. Full Quality Assurance reviews will be conducted at least once every three years or all individuals
              receiving residential services (supported living, IO waivers, Level one, and Martin waivers).
           b. The Quality Assurance Specialist or Provider Compliance Specialist/Designee will conduct a full
              Quality Assurance Review at a minimum, once every three years. The Quality Assurance Specialist
              or Provider Compliance Specialist/Designee will use quality assurance forms/templates when
              completing full reviews. A written summation including all findings and recommendations will be
              sent to the individual and his/her team no later than three weeks after the completion of the review,
              barring any unforeseen circumstances.
           c. Following the Individual Plan meeting, the Service Coordinator should complete the Improvement
              Plan Form attached to the back of the Summary of Findings and return it to the Quality Assurance
              Specialist or Provider Compliance Specialist/Designee along with a copy of all
              documentation/outcomes, which will then be stapled and filed together with the original Quality
              Assurance Review.

          ***Should one of the Q uality Assurance re commendations be a He alth/Safety Issue, the Quality
             Assurance Specialist or Pro vider Compliance Specialist/Designee will issue an Improv ement
             Plan to th e Residential Provider/Service Coordinator. T he Health/Safety issue will be
             addressed immediately and th e Quality Assurance Sp ecialist or P rovider Compliance
             Specialist/Designee will complete follow-up.

     2.    QUALITY ASSURANCE WORKSHOP/DAY PROGRAM REVIEWS:

           a. The Quality Assurance Specialist or Provider Compliance Specialist/Designee will complete a
              Quality Assurance Adult Services/Day-Programming Review for each individual enrolled in Adult
              Services or is the individual has a waiver for adult day programming. If the individual receives
              Residential Services, the Adult Services Review will be included with the full review. All
              recommendations will be forwarded to the Individual’s Service Coordinator and/or Program
              Instructor.

           b. The Service Coordinator and/or Program Instructor should address the Quality Assurance Adult
              Services recommendations with the team at the Annual Plan Meeting. All issues addressed should
              be documented in the meeting minutes.

           c.   The Service Coordinator or Program Instructor should complete the “Improvement Plan” area of the
                Quality Assurance Adult Services Review form and forward it along with a copy of the Individual
                Plan and meeting minutes (if applicable) to the Quality Assurance Specialist or Provider
                Compliance Specialist/Designee.



                                               Quality Assurance Reviews
                                                       Page 2 of 3
                                                                                                        Effective 12/07



           *** Should one of the Quality Assurance r ecommendations be a He alth/Safety Issue, the
           Quality Assurance Specialist or Provider     Compliance Specialist/Designee will issue an
           Improvement Plan to the Service Coordinator/Program Instr uctor. The Health/Safety issue
           will be addressed immediately and the Qualit y Assurance Specialist or Provider Compliance
           Specialist/Designee will complete follow-up.

E.   The Quality Assurance interview with the individual shall be scheduled by the Quality Assurance
     Specialist/Designee at a time, date, and location of the individual's choosing. The Quality Assurance
     Specialist or Provider Compliance Specialist/Designee will also schedule all other interviews.

F.   At least one of the individual’s contracted providers will be contacted and interviewed to discuss the
     individual’s responses to the Quality Assurance Review, if applicable.

G.   After all parties have been interviewed; the Quality Assurance Specialist or Provider Compliance
     Specialist/Designee shall complete a Quality Assurance Review Report. The report will include
     information regarding the following issues:

      1.      Areas where positive outcomes of the services were experienced by the individual; and
      2.      Identification of services, supports, and activities that merit improvement, and/or are no longer
              wanted by the individual.

H.   The report shall be forwarded to the individual, the parent(s), or guardian if applicable, the affected
     service provider(s), and the person responsible for coordinating the development of the individual's ISP.

I.   If the report indicates the need to address service issues, the Quality Assurance

     Specialist/Designee shall resolve these issues with input from the affected parties. Each affected party will
     be notified within 21 calendar days after the report is completed per a Quality Improvement Plan.

J.   The Quality Assurance Specialist or Provider Compliance Specialist/Designee shall develop and maintain
     a schedule of Quality Assurance Reviews.

K.   When the Agency receives notification from ODODD that ODODD intends to conduct a Quality Assurance
     review in Warren County, the Quality Assurance Specialist or Provider Compliance Specialist/Designee
     shall notify all pertinent parties of the date, time and location of the review.


APPROVED:


                                                                                March 26, 2010
       Megan K. Manuel, Superintendent                                              Date




                                           Quality Assurance Reviews
                                                   Page 3 of 3
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

COMPLAINT PROCESS                                                                            SECTION 2.08


PURPOSE/GOAL:

To ensure that the complaint process is followed when and individual is complaining about services
offered the Warren County Board of DD.

PROCEDURE:

A. Initial Complaint:
   When a complaint is made, the Supervisor or Division Director of the specific service area should
   respond immediately to the person with the concern.

    If an immediate response is not possible, inform the individual that you will look into the matter and
    inform him/her of when you will get back with them. In general, all initial return calls should be made
    within one working day. Use the Complaint Report form (AGF-113) to document your
    conversations/information received.

    If the complaint needs to be directed to another Division Director or Supervisor, inform the person that
    this needs to be sent to another division and immediately call the person to whom you are forwarding
    the complaint.

    Complete the Complaint Report (AGF-113) and forward a copy to the Director you are forwarding the
    issue to.

B. Response:
   Contact the individual with the complaint as soon as possible, but within 2 working         days of the
   initial complaint. Inform the individual of the action that has been or will be taken to address the
   concern. If the individual is not satisfied, invite further dialogue and/or inform him/her of the formal
   grievance/administrative resolution of complaints procedure.

    Complete the Complaint Report form (AGF-113) and forward a copy of the form to the Quality
    Assurance Director.

C. The Quality Assurance Director will follow up with a call to each individual complainant.

D. Track Complaints for Trends and Service Improvement:
   The Quality Assurance Director will track all complaints received by the agency and an annual trends
   report will be developed and shared with the Superintendent. Recommendations for service
   improvements will be made if needed.


APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                             Complaint Process
                                               Page 1 of 1
                                                                                                    Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

AGENCY ASSISTANCE OF ADMINISTRATIVE RESOLUTION                                              SECTION 2.09
OF COMPLAINT PROCESS

PURPOSE: To ensure that each enrolled individual and his/her family is assisted with a grievance or a
formal appeal of the Administrative Resolution of Complaint process.

PROCEDURE:

A. When an individual/family is informed of ineligibility or given detailed description of a program or
   service change, denial or deduction of services and is provided a reason for the proposed action or
   refusal to initiate action, the individual may file a grievance with the administration. The
   individual/family will be informed that a representative of the Board is available to assist the
   individual/family with the grievance or formal appeal process. The appeal of any action of the Board
   shall begin at the level in which the decision/action was made.

B. The Superintendent/designee will initially provide the individual/family with a copy of the Agency
   policy on Administrative Resolution of Complaints/Due Process.

C. If the individual/family requests assistance in the grievance/appeal process, the Director of Quality
   Assurance/designee will act as the agency representative and offer assistance in the
   grievance/appeal process. The Director of Quality Assurance/designee will follow the following
   process:

   1. A letter will be sent to introduce the agency representative and provide an additional copy of the
      policy on Administrative Resolution of Complaint/Due Process
   2. A file will be created to document the steps of the grievance/appeal process (identifying the
      mandated days of contact and response to decisions) according to the agency policy.
   3. Case notes will outline all contacts regarding the grievance/appeal and will be kept in the file.

D. If the individual/family is appealing a decision regarding the       denial, reduction or termination of
   Medicaid funded services, the Medicaid Due Process will               apply.   The Director of Quality
   Assurance/designee will provide a copy of the Ohio Department        of Human Services forms regarding
   the appeal process and provide assistance in completing those        forms the individual/family requests
   assistance.



APPROVED:


                                                                                   March 26, 2010
         Megan K. Manuel, Superintendent                                               Date




                     Agency Assistance of Administrative Resolution of Complaint Process
                                                Page 1 of 1
                                                                                             Effective 03/10




                WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                               AGENCY PROCEDURE

SAFE ENVIRONMENT                                                                      SECTION 2.10


PURPOSE:      To provide a safe environment in which to receive agency services.

PROCEDURE:

A. IN ORDER TO ALLOW FOR QUICK AND ORDERLY RESPONSE TO EMERGENCY SITUATIONS:

  1. Evacuation plan for fire, tornado, and other emergencies shall be posted in each room or special
     area of the facility.
  2. Fire extinguishers, fire gongs, and alarms shall be properly located, identified and kept in good
     working order.
  3. All hallways, entrances, ramps, and corridors shall be kept clear and unobstructed at all times.
  4. Storage areas for combustible or flammable materials shall be effectively separated from rooms
     and work areas in such a way as to minimize and inhibit the spread of fire




APPROVED:


                                                                            March 26, 2010
       Megan K. Manuel, Superintendent                                          Date




                                          Safe Environment
                                             Page 1 of 1
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

SAFE WORKING ENVIRONMENT                                                                   SECTION 2.11


PURPOSE: To provide for safe working conditions for agency employees and participants by preventing
unsafe use of equipment and extension cords.

PROCEDURE:

   A. Power equipment both fixed and portable shall have operating safeguards as required by the
      Division of Safety and Hygiene, Bureau of Worker’s Compensation. No employee shall knowingly
      remove safeguards or operate equipment that has had safeguards removed, and shall
      immediately report any such equipment to their supervisor and discontinue its’ use.

   B. Supervisors shall regularly (at least monthly) check their areas of responsibility for appliances and
      other electrical devices improperly connected to extension cords and remove them from service.




APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                        Safe Working Environment
                                              Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

MEDICAL EMERGENCIES                                                                        SECTION 2.12


PURPOSE: To establish guidelines for the transportation of persons who become injured or ill at WCBDD
facilities or work sites, and require transportation to emergency facilities of treatment.

PROCEDURE:

A. Whenever an individual is injured or becomes ill to the extent that a trip to an emergency treatment
   facility is necessary, it will be the procedure of WCBDD to transport through the use of emergency
   vehicles (emergency squad).

B. Injured or seriously ill persons should not be transported by WCBDD vehicles/staff unless prior
   Superintendent approval is granted.

C. Emergency vehicles should pick up injured or ill persons at areas designated by Division Directors for
   each location.

D. Division Directors shall assign a staff person to either ride with the person being transported, or meet
   the person at the emergency treatment facility. Staff shall remain at the treatment facility until the
   person is released, or is met by family, or residential provider.

E. In the event of health reason transportation, the agency administrator on duty and the Division
   Director, or designee will be notified immediately.




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                      Medical Emergencies Procedure
                                               Page 1 of 1
                                                                                                    Effective 03/10




                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

PROGRAM PLACEMENT – SAFETY                                                                   SECTION 2.13


PURPOSE:      To maximize the safety of enrolled individuals and staff members while providing services
and programming to as many individuals as possible.

PROCEDURE:

When the safety of the individual and/or others cannot be reasonably assured, the participant’s program
placement shall automatically be evaluated.

A. THE EVALUATION TEAM SHALL INCLUDE AT A MINIMUM (AS APPLICABLE):

    1.    Individual
    2.    Parent or Guardian
    3.    Behavior Support Specialist
    4.    ICFMR Behavior Specialist
    5.    Program Instructor
    6.    Service Coordinator
    7.    Safety Committee Representative
    8.    Adult Services Director
    9.    Adult Service Provider
    10.   Related Service Providers
    11.   Residential Provider Representative

B. AREAS OF CONSIDERATION AND DISCUSSION SHALL INCLUDE (AS APPLICABLE):

    1.    Functional analysis of behavior in accordance with the Administrative Code 5123: 2-1-02.
    2.    Alternate methods of intervention
    3.    Additional training for Adult Service Provider (s)
    4.    Alternate programming within existing placement

In the event that the safety of the individual, staff, and/or other participants cannot be reasonably assured,
current program placement may be suspended and/or terminated and an alternate program placement
shall be sought.


APPROVED:


                                                                                   March 26, 2010
           Megan K. Manuel, Superintendent                                             Date




                                         Program Placement – Safety
                                                Page 1 of 1
                                                                                                  Effective 03/10




                     WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                    AGENCY PROCEDURE

SAFETY COMMITTEE                                                                            SECTION 2.14


PURPOSE:          The Safety Committee shall serve as the authority for overseeing the safety services of
this agency.

PROCEDURE:

A. COMPOSITION OF THE COMMITTEE

    1.   Operations Director, Chairperson
    2.   Agency RN
    3.   Maintenance Specialist
    4.   Adult Services Procurement Specialist
    5.   Agency Investigative Agent

    Should a committee member not be able to attend a scheduled meeting, a representative should be
    appointed to attend the meeting on behalf of the committee member.

    The Chairperson shall be responsible for notifying committee members when a meeting is scheduled,
    providing reports, etc., to be reviewed, and maintaining written reports of all meetings held.

B. MEETINGS

    The Safety Committee shall meet whenever necessary, but at least quarterly.

C. MINUTES OF MEETINGS

    1. The Operations Division shall maintain documentation of meetings, findings and recommended
       corrective action. Such reports must be reviewed and approved by the Chairperson.

    2. The chairperson shall sign all minutes of meetings.

    3. Minutes of meetings shall contain, at a minimum:

         a.    Date and time of meeting;
         b.    Members present/absent;
         c.    Findings and recommended corrective action;
         d.    Follow-up action, as appropriate;
         e.    Signature of chairperson; and
         f.    Other information deemed appropriate by the committee.

D. DUTIES AND RESPONSIBILITIES

    Duties and responsibilities of the Safety Committee include, but are not limited to:

    1. Developing written safety policies and procedures and recommending their approval by the
       Board;

    2. Reviewing all accident/incident reports and making recommendations for corrective action;

    3. Identifying hazardous areas and unsafe work practices and suggest appropriate remedies;


                                              Safety Committee
                                                 Page 1 of 2
                                                                                              Effective 03/10




  4. Developing and implementing an effective safety training program;

  5. Developing and implementing safety rules and regulations for each department;

  6. Coordinating safety committee functions with other committees as appropriate;

  7. Following up on recommendations and corrective action plans for reported violations;

  8. Assuring that appropriate government reports are filed on time and in accordance with
     established procedures;

  9. Assuring that appropriate safety equipment and protective equipment is on hand and used as
     instructed;

  10. Assuring that the facility is maintained in a clean and safe manner;

  11. Assuring that storage areas are clean and are properly used;

  12. Encouraging feedback from all employees with regard to safety problems, ideas, and solutions;

  13. Identifying recurring safety-related problems and develop appropriate prevention measures;

  14. Assuring that fire safety and disaster preparedness drills are conducted in accordance with
      current policies;

  15. Conducting periodic safety inspections;

  16. Assuring that a preventive maintenance schedule is maintained to keep the facility equipment in
      an operable manner;

  17. Assisting the Division RN in developing and implementing the division’s exposure control plan
      relative to blood borne pathogens.

  18. Assisting the Division RN in developing and implementing the division’s hazard communication
      program relative to hazardous chemicals used or stored in the facility.




APPROVED:


                                                                             March 26, 2010
       Megan K. Manuel, Superintendent                                           Date




                                           Safety Committee
                                              Page 2 of 2
                                                                                                      Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

BUILDING SAFETY                                                                             SECTION 2.15


PURPOSE:        To provide for the safety and welfare of building occupants in the event of a fire.

PROCEDURE:

A. At least one person in every building shall be trained in techniques of fire suppression. At the Banta
   Center, both administrative assistants shall take the training.




APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                               Building Safety
                                                Page 1 of 1
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

POST EXPOSURE EVALUATION AND FOLLOW UP                                                    SECTION 2.16


PURPOSE:        To reduce occupational exposure to Hepatitis B (HBV), Human Immunodeficiency Virus
(HIV) and other blood-borne pathogens that employees/staff might encounter during their course of their
duties.

PROCEDURE:

A. When an employee incurs a known or suspected exposure, it will be reported immediately to the
   Nursing Supervisor or other available nurse. Designated first-aid providers will report any scenario
   involving blood or OPIM (Other potential infective materials) to the Nursing staff as soon as the
   exposure occurs.

B. The Nursing staff will begin the Exposure Incident Investigation and follow exposure protocol.

C. The nursing staff will complete the Post-Exposure Evaluation form and checklist and maintain it, in a
   confidential file.

D. If the source individual can be identified, the nursing staff will ask the individual or individual’s
   guardian to have the individual’s blood tested and the results be given to the exposed employee and
   the employee’s personal physician.

E. If the source individual has been determined to have also had an exposure (i.e. a bite) then the
   Participant Post-Exposure and follow-up procedure will be followed.



APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                  Post Exposure Evaluation and Follow Up
                                               Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

INFECTION CONTROL                                                                          SECTION 2.17


PURPOSE:      To ensure a safe and healthy work environment for all staff and individuals enrolled in
agency programs.

PROCEDURE:

A. ATTENDS CHANGING AND DIRECT TOILET ASSISTANCE:

   1. Whenever possible participants shall use bathrooms for toileting. If individuals in any
      group/classroom require changing, a changing area shall be established and have needed
      supplies readily available. Attends or clothing used during changing and sent from the home
      shall be stored in a space assigned exclusively for the participants belongings.

   2. Any product used during Attends changing on more than one participant shall be used in such a
      way that the container does not touch the participant. Any product obtained from a common
      container and applied to a participant shall be applied in such a manner so as not to contaminate
      the product or the container. Common containers shall be cleaned and disinfected with an EPA
      approved germicidal agent when soiled.

   3. Staff changing Attends or providing assistance that involves wiping an individual with toilet tissue
      or wet wipes, disposing of toilet tissue, wet wipes or Attends, changing soiled clothing, and/or
      cleaning soiled changing tables, mats or other areas shall wear gloves.

   4. Staff who engage in any of the above mentioned activities shall remove gloves and wash hands
      thoroughly before engaging in other activities.

   5. Disposable separation material shall be placed between the participant and the changing surface
      prior to Attends changing. This material shall be discarded and replaced after each change.

   6. Changing tables and mats used for Attends changing shall be disinfected after each Attends
      change with an approved EPA germicidal agent. Tables and mats that have been soiled during
      changing shall be cleaned with soap and water and then disinfected with an EPA approved
      germicidal agent.

   7. Soiled Attends shall be placed in plastic bags in specific containers for such use. Bags shall be
      properly closed, disposed on a daily basis, and containers disinfected.

   8. Soiled clothing shall be placed in a plastic bag (it need not be rinsed first), sealed tightly, stored
      away from the rest of the individual’s belongings and out of each of the individual, and be sent
      home with the person on a daily basis. Soiled clothing should be double bagged.

B. HAND WASHING:

   Hand washing is indicated in the following circumstances:

   1.   Immediately after contact with blood or body fluids.
   2.   After handling potentially contaminated objects.
   3.   After toileting or assisting with toileting.
   4.   Before and after eating or assisting with feeding.


                                              Infection Control
                                                 Page 1 of 2
                                                                                               Effective 03/10




   5.   After removal of gloves.
   6.   Before caring for another person.
   7.   After using the restroom.
   8.   After returning from break.
   9.   Before and after smoking

        a. Regulate water to a comfortable temperature and leave on during procedure.
        b. Keep hands and forearms lower than elbows to reduce contamination.
        c. Wet hands and soap them well. Wash fingers, hands, and fingernails with firm, rubbing,
           circular motions for a minimum of 15 seconds.
        d. Rinse hands and fingers thoroughly under running water.
        e. Wash mid forearms, wrists, and hands completely again using firm, rubbing, circular motions.
        f. Rinse forearms, wrist and hands under running water starting at the forearms and moving
           towards the fingertips. Avoid splashing.
        g. Dry hands with a paper towel or air dryer.
        h. Turn faucet off with dry paper towel.

C. HAND SANITIZER:

   1. Hand sanitizer may be used. Apply sanitizer directly to hands and rub hands together tightly until
      dry.
   2. If hands are grossly contaminated, soap and water should be used.
   3. Hand sanitizer may be used after washing with soap and water.

D. CLEANING AND DISINFECTING:

   1. Equipment surfaces (tables, disk, mats, etc.) shall be washed on a routine basis and disinfected
      as needed.
   2. Educational materials other “mouthable” equipment shall be washed after use, if contaminated
      with saliva. Limited sharing of this type of equipment shall be considered.
   3. Surfaces used for changing Attends shall be cleaned as described in above Attends changing
      procedure.
   4. Wedges, beanbags, linens, blankets, etc. used by an ill individual shall be cleaned and laundered
      after each use.



APPROVED:


                                                                              March 26, 2010
         Megan K. Manuel, Superintendent                                          Date




                                            Infection Control
                                               Page 2 of 2
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

SEIZURE RESPONSE & REPORTING                                                             SECTION 2.18



PURPOSE:         To provide guidelines when responding to and documenting/reporting seizures of
enrolled individuals.

PROCEDURE:

A. Follow CPR/First Aid training.

B. Call nurse for uncharacteristic seizures or seizures lasting longer than 5 minutes.

C. Report seizure on Seizure Report form.

D. Route completed form as follows:

    1. Original
    2. Nurse
    3. Copy

        a.   Program Instructor/Teacher
        b.   Service Coordinator
        c.   Individual’s Main File
        d.   Parent/Group Home/Guardian




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                       Seizure Response & Reporting
                                                Page 1 of 1
                                                                                                  Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMPLOYEE INCIDENT AND INJURY                                                               SECTION 2.19



PURPOSE:

To provide guidelines to all staff when documenting/reporting an incident or injury to an employee.

PROCEDURE:

A. Any incident or injury involving an employee shall be reported immediately to their supervisor.

B. Verbal notification must be made to the Human Resource office immediately if medical treatment is
   needed.

C. Employees shall use the Employee Incident and Injury Report form, #AGF-011, when documenting
   an incident or injury to an employee.

D. Routing order of the Employee Incident and Injury Report form #AGF-011 is as follows:


    1. ORIGINAL

        a.   Immediate Supervisor who forwards to nurse.
        b.   Nurse forwards to Human Resource office (within 24 hours).
        c.   Human Resource forwards to Superintendent
        d.   File in Accident Report Notebook

    2. COPY

        a.   Division Director
        b.   Safety Chairperson
        c.   Worker’s Comp File
        d.   Warren County O. M. B.




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                        Employee Incident and Injury
                                               Page 1 of 1
                                                                                                   Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

MEDICAL EMERGENCIES ON TRANSPORATION                                                        SECTION 2.20


PURPOSE: To establish guidelines for staff to follow should a medical emergency arise while transporting
participants to/from home or to/from the Adult Services facilities or while on an outing.

PROCEDURE:

A.      G-TUBE OR J-TUBE

        1. In the event the G-Tube or J-Tube pulls out of the participant while being transported, the bus
           assistant/staff should cover the site with gauze and tape. Bus assistant/staff should not try to
           insert tube.

        2. If the participant is receiving tube feeding at the time if G-Tube or J-Tube pulls out, the bus
           assistant/staff should turn off the tube-feeding pump or clamp the feeding tube.

        3. Staff should contact the nursing staff at home/PSU and return to the home/PSU (which ever
           is closer). The nursing staff (home/PSU) should meet the vehicle upon arrival. The tube
           should be reinserted within 30 minutes after it came out the participant. The home/PSU
           nursing staff should then contact the Doctor for further instruction, if they are unable to insert
           a new tube.

        4. Medical emergencies that include but are not limited to seizure, bee stings, diabetic crisis,
           head injuries and lacerations should be handled in the following manner:

B.      SEIZURES:

        1.    In the event a participant experiences a prolonged seizure the bus assistant/staff should
              evaluate the situation.

                        a. If less than 5 minutes away from home/PSU the driver should contact the
                           home/PSU and return to the facility. The nursing staff should be notified and
                           meet the bus/van.
                        b. If the vehicle is more than 5 minutes from home/PSU the driver should
                           contact 911 and follow the directions of the dispatcher as to where to meet
                           the squad.
                        c. The bus assistant/staff should follow the seizure care procedures posted in
                           the vehicle.

        2. All other medical emergencies that occur should be handled in the following manner:

                        a. Staff should refer to the participant’s emergency medical form
                        b. Staff should follow first aid procedures
                        c. Staff should contact the home/PSU nursing staff (which ever is closer) for
                           direction promptly.




                                   Medical Emergencies on Transportation
                                               Page 1 of 2
                                                                                               Effective 03/10




     3. If the participant requires CPR, has profuse bleeding/severe laceration, suffers a head injury
        or becomes unconscious, staff should contact 911. Staff should follow direction given by the
        911 dispatcher. The staff should then contact home/PSU.

C.   TRACHEOSTOMY

     1. Participants who have tracheostomies will have no restriction during transportation. A spare
        trach will always be in their backpack and a nurse/physician must reinsert the trach if it is
        dislodged. If a respirator emergency should occur during transport per policy, 911 is to be
        called and the staff should follow the directions given by the dispatcher. The staff should
        then contact the PSU/Group Home nursing staff.

     2. When transporting a stable participant with tracheostomy a short distance such as workshop,
        doctor’s appointment and short outings, no special equipment will be required in the
        transportation vehicle. The vehicle will contain a cell phone or radio to be used in the event
        of an emergency.

     3. If a respiratory emergency should occur during one of these events the following should be
        done:

             a. Call 911 and follow the dispatcher’s direction.
             b. Notify Residential Provider Nursing Staff and they will contact the physician and all
                other appropriate individuals.

     4. If a trach would come out while in transport, but it is not a respiratory emergency, notify the
        nurse at PSU/Group Home promptly so they can immediately call the physician (only a nurse
        or physician can replace the trach). But if it is respiratory emergency, call 911 and follow the
        directions given by the dispatcher. The staff should then contact the Group Home/PSU
        nursing staff.

     5. A spare trach will always be in the backpack.

     6. Any special needs for participants will be participant specific and will be met per physician
        orders.

APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                                Medical Emergencies on Transportation
                                            Page 2 of 2
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMERGENCY DRILLS                                                                             SECTION 2.21


PURPOSE: To ensure the safety of all enrolled individuals/staff in the event of an emergency.

PROCEDURE:

A. Emergency Procedures for each WCBDD building shall be rehearsed based on the following
   schedule:

    1. Fire evacuation procedures – monthly, occasionally blocking one or more exits to test alternate
       routes
    2. Tornado procedures – monthly April through August
    3. All other emergency procedures shall be rehearsed at least twice per year. The Operation
       Division Director shall utilize the “DD Works” Environmental Health and Safety task planner to
       schedule and notify divisions of the procedure(s) to be conducted each month.

B. All drills shall be practiced according to the procedure and documented by the person(s) conducting
   the drill, including the time elapsed during the drill and a written analysis of the conduct and
   effectiveness of the drill as well as any follow-up completed or recommended. This documentation
   shall be kept on site and a copy forwarded to the Chairman of the Safety Committee for review and
   follow up.

C. In building with multiple shifts, emergency procedure shall be practiced on all shifts.




APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                              Emergency Drills
                                                Page 1 of 1
                                                                                                    Effective 03/10




                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

FIRE EVACUATION/FIRE DRILLS – WARREN C. YOUNG CENTER                                         SECTION 2.22


PURPOSE: To ensure safe evacuation of facilities in the event of a fire.

PROCEDURE:

A.       CONDUCTING FIRE DRILLS:

     1. The Early Intervention Coordinator of Services will implement a fire drill at least monthly. The
        director will instruct their administrative secretary or a designee to follow procedures below:

             a. Call Bellamy Alarm Company at 1-800-626-9364
             b. Call WCBDD Transportation 228-4025
             c. Call Fire Department at 932-2010
             d. Tell them this is a test for Account number- 6497-B
             e. Have stopwatch ready
             f. To begin drill push 2, 0, enter and code (1234) in keypad located at the front of each
                facility.
             g. Press stopwatch as alarm goes off.
             h. Follow evacuation plan
             i. Push stopwatch to stop time
             j. Reset alarm by pressing reset, enter and 1234
             k. Call Bellamy back to make sure the alarm monitoring system is on line
             l. Call WCBDD Transportation to inform drill is complete
             m. Call Fire Department to inform drill is complete.

     2. The facility director/designee will complete a WCBDD Emergency Drill Documentation sheet and
        submit a copy to the Safety Chairperson at the Administration Office. The original sheet should
        be placed in the Emergency Drill Documentation book located in each facility.              The
        director/designee should note any recommendations regarding the drill and note any follow-up
        action taken as a result of the recommendation. The Safety Committee Chairperson shall review
        drill sheets for evidence of follow-up by monitoring for abnormalities and patterns of
        abnormalities. The Safety Committee Chairperson shall refer any such patterns to the Safety
        Committee for review and resolution.

     3. Drills will be scheduled at different times of the day. Occasionally, an exit will be deliberately
        blocked so that the staff and employees will be familiar with alternative routes.

B.       EVACUATION – Warren C. Young Center

     1. Employee/individual who suspects or discovers a fire shall activate the emergency pull station
        located closest to them. The locations of all pull stations are identified on the attached floor plan.
        Floor Plans are posted in all areas of the building.

     2. All building occupants shall exit following the posted evacuation routes to their designated
        assembly points at the far side of the parking lot opposite their point of exit.

     3. At the sound of the alarm, the Division Secretaries/designees will take the attendance roster
        (including all on premises individuals, staff and visitors) and the staff and any enrolled individuals
        emergency medical authorization books, sign in/out clipboards, and MSDS book out of the
        building.


                              Fire Evacuation/Fire Drills – Warren C. Young Center
                                                   Page 1 of 2
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     4. Early Intervention staff shall bring a first aid kit from their area to their designated assembly point.

     5. Staff will assist individuals in evacuating the building in a calm, quiet manner by routes
        designated on maps located in each room. In case the primary routes are blocked in any way,
        the alternative exits will be used.

     6. Division Directors/designees will check their assigned areas of the building. Once the assigned
        area is clear, the Division Directors/designees should report to their evacuation area.

     7. In the event of an actual fire, the Division Directors/designees will report to the fire squad the
        number of individuals (if any) who are believed to still be in the building.

     8. Staff/individuals will remain in their assigned evacuation sites until the “All Clear” is given by
        their Division Directors/designees.

     9. If the fire presents a continuing danger or the building is rendered no longer habitable, individuals
        will be evacuated to the Production Services building. DD Transportation will be contacted by the
        Division Directors/designees and arrangements made to transport any enrolled individuals to their
        homes.

C.     FIRE TRAINING/INSPECTION

     1. Annually, and as changes occur, staff will be trained on fire evacuation and drill procedures.

     2. Designated staff will be trained by the local fire chief/designee on proper fire suppression
        techniques.

     3. Annually, the Early Intervention Coordinator of Services shall request the local Fire Department to
        inspect the Warren C. Young Center for compliance with local fire codes.


APPROVED:


                                                                                      March 26, 2010
          Megan K. Manuel, Superintendent                                                 Date




                               Fire Evacuation/Fire Drills – Warren C. Young Center
                                                    Page 2 of 2
                                                                                                   Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

TORNADO EMERGENCY – WARREN C. YOUNG CENTER                                                    SECTION 2.23


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a tornado.

PROCEDURE:

A.     TORNADO WATCH

       1.      Occupants will be alerted by a weather radio located in the Early Intervention Secretary’s
               office. An announcement will be made that a tornado watch is in effect.

       2.      Announcements on the weather radio will be monitored by the Early Intervention
               Secretary

       3.      Non-ambulatory individuals should get into their wheelchairs to be
               prepared for possible evacuation.

       4.      Individuals should continue programming and staff will review tornado
               plans with groups in anticipation of movement to designated areas.


B.     TORNADO WARNING

       1.      Upon notification of a tornado warning from the weather radio,
               the Early Intervention Director/designee will activate a long continuous
               warning signal with an air horn. An announcement will also be made notifying
               staff/individuals of the tornado warning.

       2.      All individuals will report to the shelter area designated on the map posted in each room.

       3.      The Division Secretary of the Early Intervention Division will collect all sign-in sheets
               and attendance rosters and take them to the Early Intervention Coordinator of
               Services/designees.

       4.      Upon arrival to their designated areas, all individuals will assume shelter-
               body position as follows:

                       a. Sit on the floor facing interior wall
                       b. Head between knees
                       c. Place coat/blanket over head
                       d. Persons in wheelchairs will remain in their chairs

       5.     The Division Directors/designees will check to ensure that everyone is in their assigned
              areas and accounted for.

       6.      Injuries should be reported to the Division Director/designee.

       7.      Everyone should remain in their designated areas until an all clear is
               sounded/announced by their Division Director/designee.


                              Tornado Emergency – Warren C. Young Center
                                             Page 1 of 2
                                                                                               Effective 03/10




C.   DRILLS

     1. The Early Intervention Director/designee will implement a tornado drill once a month during
          tornado season (April - August) or more frequently as determined by the Facility
          Director/designee.

     2. The Early Intervention Coordinator of Services/designee will instruct the Secretary or other
        designated staff person to proceed with the following:

             a.   Get stopwatch and air horn or whistle.
             b.   Announce the drill and blow horn.
             c.   Start the stopwatch to time the drill.
             d.   Monitor drill by making sure everyone is in the appropriate tornado shelters.
             e.   Once everyone is in, make sure there is at least one Disaster Kit in each area.
             f.   Stop the watch for time.
             g.   Announce “all clear.”

     3.      The E.I. Director/designee will write Emergency Drill Documentation sheet and submit a
             copy to the Safety Chairperson, Administrative Secretary, Administration Office. The
             original sheet should be kept in E.I Secretary’s office.

     4.      Any issues/concerns that arise as a result of the drill will be discussed with staff at the
             next staff meeting.



APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                             Tornado Emergency – Warren C. Young Center
                                            Page 2 of 2
                                                                                                  Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

POWER FAILURE – WARREN C. YOUNG CENTER                                                     SECTION 2.24


PURPOSE: To ensure safety of enrolled individuals/staff of Warren C. Young Center in the event of a
power failure.

PROCEDURE:

A.   POWER FAILURE

     1. The facility will remain status quo until the power company either remedies the situation, or the
        Division Directors/designees deem it to be in the best interest of their Division to close the
        facility for their division.

     2. If the facility is to be closed, the Division Directors/designees will notify the Superintendent and
        the Transportation Division if necessary to have enrolled individuals transported home.

B.   LIGHTING

     1. Emergency back up lighting is located throughout the building.

     2. Battery powered emergency lighting will be tested once a month by the facility maintenance
        representative and once quarterly during the internal inspection.

C.   FIRE ALARM/ INTRUSION ALARM SYSTEMS

     1. The fire alarm and intrusion alarm systems also has a battery operated back up power source
        in the event of a power failure.

           a. The Alarm Company representatives will test the emergency back up yearly.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                  Power Failure – Warren C. Young Center
                                                Page 1 of 1
                                                                                                 Effective 03/10




                     WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                    AGENCY PROCEDURE

BOMB THREAT – WARREN C. YOUNG CENTER                                                       SECTION 2.25


PURPOSE: To ensure the safety of all enrolled individuals/staff in the event of a bomb threat.

PROCEDURE:

A.      UNUSUAL ACTIVITY

        1. Staff should report any unusual circumstances, persons, or objects in the building or
           surrounding area, to their Director/designee.

        2. If deemed necessary, their Director/designee should evacuate the facility. See “C. Notifying
            Director.”

B.      WHEN BOMB THREAT IS RECEIVED

        1. Keep caller on the line as long as possible
        2. Do not hang up or disconnect the line
        3. Direct other personnel to call the operator and request an emergency trace stating, “We
           have a BOMB THREAT.”
        4. Other personnel (secretary, Director, etc…) should contact Warren County
           Telecommunications (ext. 1320) and tell them that there has been a bomb threat. Report,
           which line the caller, is on and ask that the line be traced.
        5. Attempt to gain the following information:
                a. location of the bomb
                b. time of detonation
                c.    name of caller
                d. identifying characteristics of caller’s voice

C.      NOTIFYING DIRECTOR

        1. The Director/designee will activate the fire alarm and evacuate the building immediately.

        2. The Director should immediately inform the Lebanon Police/Fire
           Department of the bomb threat.

        3. Once the safety of all persons is ensured, the Superintendent will then be notified. If the
           building cannot be re-entered the Superintendent or designee will notify the transportation
           division and arrange to have enrolled individuals transported home or to the emergency
           evacuation site (PSU).
        4. Staff will remain until all enrolled individuals have been picked up.

        5.   No person will be permitted to enter the building until it has been declared safe by the
             Superintendent or Director/designee.


                                       Bomb Threat – Warren C. Young Center
                                                    Page 1 of 2
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     6. If evacuation occurs during inclement weather, staff should assist enrolled individuals to the
         emergency evacuation site, Production Services Unlimited.


APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                               Bomb Threat – Warren C. Young Center
                                            Page 2 of 2
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EARTHQUAKE EMERGENCY – WARREN C. YOUNG CENTER                                             SECTION 2.26


PURPOSE: To ensure the safety of all enrolled individuals and staff at the Warren C. Young Center in the
event of an earthquake.

PROCEDURE:

A.      IF INDOORS DURING AN EARTHQUAKE

           1.      When you feel an earthquake, all individuals should be relocated to a tornado shelter,
                   individuals using wheelchairs should be positioned as close as possible to supporting
                   walls. All other persons should move or stay away from windows, file cabinets,
                   bookcases, heavy mirrors, hanging objects, or ceiling tiles. Stay under cover until the
                   shaking stops.

           2.      When it is believed safe, the Ranking Administrator or designee will initiate
                   evacuation of the area by using the FIRE EVACUATION PROCEDURE.

           3.      Maintenance staff or designee will secure and shut off the utilities to the building,
                   following emergency shut off procedure.

B.     IF OUTDOORS DURING AN EARTHQUAKE

           1.      Do not enter the building. Proceed to the closest FIRE EVACUATION waiting area.

           2.      Move away from all structures, utility poles, downed power lines, trees and signs.

            3.     If you are driving pull over to the side of the road and stop. Avoid overpasses, power
                   lines and other hazards. Stay inside the vehicle until the shaking stops.

C.      AFTER THE EARTHQUAKE STOPS

            1.     The Senior Director on site or designee will assure that all participants and
                   employees are accounted for. A list of any missing persons and their possible
                   whereabouts will be compiled.

           2.      The Senior Administrative staff or designee will coordinate the assessment of any
                   injuries and will be assisted by the first aid team. A nurse or designee will report to
                   the Senior Administrative staff on site or designee, who will arrange to call the
                   EMERGENCY SQUAD if anything other than routine FIRST AID is required.

           3.      The Senior Administrative Staff on site or designee will report any missing persons to
                   the Lebanon Fire Department.

           4.      If the facility is to be closed, transportation will be notified and individuals will be
                   evacuated to their homes or the emergency evacuation site (PSU)




                             Earthquake Emergency – Warren C. Young Center
                                              Page 1 of 2
                                                                                         Effective 03/10




APPROVED:


                                                                        March 26, 2010
      Megan K. Manuel, Superintendent                                       Date




                        Earthquake Emergency – Warren C. Young Center
                                         Page 2 of 2
                                                                                                Effective 03/10




                     WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                    AGENCY PROCEDURE

TOXIC SPILL – WARREN C. YOUNG CENTER                                                     SECTION 2.27


PURPOSE: To ensure the safety of enrolled individuals and staff at the Warren C. Young Center in the
event of a toxic spill.

PROCEDURE:

A.   HAZARDOUS MATERIAL SPILLS INCL UDE THE RELEASE OF SUDDEN DISCHARGE IN
     HARMFUL OR REPORTABLE QUANTITIES OF:

     1.    Oil or other petroleum products

     2.    Hazardous waste that may be hazardous or detrimental to:

                a. Surface or ground water
                b. Air quality
                c. Surrounding land and fixtures (trees, shrubs, etc.)

     3.    Hazardous materials include:

                a.    Explosives
                b.    Flammable liquids
                c.    Water reactive substances
                d.    Oxidizing materials
                e.    Poisonous or toxic materials
                f.    Radioactive materials
                g.    Corrosive materials

     4. A material is considered hazardous material if:

                a. Specifically listed in the law, 29 CFR parts 1910 subpart Z, Toxic and Hazardous
                   Substances (Z List).
                b. Assigned a threshold limit value (TLV) by the American Conference of Governmental
                   Industrial Hygienist, Inc. (ACGIH).
                c. Determined to be cancer causing, corrosive, toxic, an irritant, a sensitizer, or has a
                   damaging effect of specific body organs.

B.   ALL SPILLS OR POTENTIAL SPILLS MUST BE REPORTED IMMEDIATELY, INCLUDING THE
     FOLLOWING:

           1.   Chemical spills
           2.   Accidents involving chemicals with potential spills
           3.   Fires with chemicals involved
           4.   Fuel tank delivery overfills
           5.   Oil spills where product enters a watercourse

C.   ENCOUNTERING A SPILL AND WHAT TO DO:

           1. All spills must be reported to the Division Director or designee.
           2. Without endangering yourself or others, try to stop the flow of hazardous materials and
              prevent the spill from spreading.


                                     Toxic Spill – Warren C. Young Center
                                                   Page 1 of 2
                                                                                                 Effective 03/10




         3. ONLY TRAINED PERSONNEL WILL BE PERMITTED IN T HE AREA TO CLEAN UP
            THE SPILL!
         4. The law requires the person having the spill to report the spill. If you know about it, you
            MUST REPORT IT IMMEDIATELY!

D.   WHEN REPORTING A SPILL GIVE THE FOLLOWING INFORMATION:

         1.   Name of person reporting the spill
         2.   Location of spill
         3.   Material involved
         4.   Estimated volume
         5.   Whether source is controlled
         6.   Whether a water source is involved

E.   INTERNAL TOXIC SPILL (SPILL OCCURRING INSIDE FACILITY), THE SENIOR DIRECTOR ON
     SITE OR DESIGNEE WILL INITIATE THE FOLLOWING:

         1. Evacuate all individuals from the facility utilizing the fire evacuation procedure.
         2. Immediately notify the Local Fire Department and the Senior Director on site or designee
            who will call 911 and ask to have the Haz Mat coordinator
            dispatched to the site (932-4080).
         3. Provide all the information to each as identified in Spill Report Information as listed in this
            procedure.
         4. FOLLOW SAFETY OFFICIALS RECOMMENDATIONS.
         5. If the facility is to be closed, the Superintendent or designee will notify the transportation
            division and arrange to have participants transported home.
         6. No individual may reenter the facility until the local authorities give the “all clear”.

F.    EXTERNAL TOXIC SPILLS (SPILLS OCCURRI NG OUTSIDE A FACILITY), THE SENIOR
      DIRECTOR ON SITE OR DESIGNEE WILL INITIATE THE FOLLOWING:

         1. Immediately notify the Local Fire Department, Environmental Protection Agency and
            provide all the information to each as identified in SPILL REPORT FORM as listed in this
            procedure.
         2. The senior director on site or designee will notify the Superintendent or designee of the
            situation.
         3. If the facility is to be closed, the Superintendent or designee will notify the transportation
            division and arrange to have participants transported home or to the emergency
            evacuation site (PSU).




APPROVED:


                                                                                March 26, 2010
       Megan K. Manuel, Superintendent                                              Date




                                 Toxic Spill – Warren C. Young Center
                                               Page 2 of 2
                                                                                                   Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EMERGENCY SHUTOFF – WARREN C. YOUNG CENTER                                                SECTION 2.28


PURPOSE: To ensure the safety of all enrolled individuals and staff of the Warren C. Young Center in
the event of an emergency requiring shut off of the utilities.

PROCEDURE:

A.     IF SHUTTING OFF THE UTILITIES TO THE BUILDING BECOME NECESSARY DUE TO
       EMERGENCY CIRCUMSTANCES DO THE FOLLOWING:

           1.      If possible, notify the Operations Director at 513-518-1848.

           2.      Locate the gas meter outside at the southwest corner of the main building (near the
                   air conditioners). Using an adjustable wrench or similar device, turn the gas cock at
                   the base of the meter ¼ turn to the off position.

           3.      Locate the water main shutoff inside the northeast mechanical room. Turn the water
                   valve ¼ turn to the off position.

           4.      Locate the electrical panels on the northeast exterior wall, and switch off the 4 main
                   boxes on the outside wall.




APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                               Emergency Shutoff – Warren C. Young Center
                                              Page 1 of 1
                                                                                                  Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

VIOLENT OR THREATENING SITUATION - WCYC                                                    SECTION 2.29


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a violent or threatening situation

PROCEDURE:

A.     Immediately upon recognition of a violent or threatening situation on or near DD property such as,
       but not limited to:

       1.      Any person in possession of a deadly weapon.

       2.      Any person observed in violent or threatening actions or behaviors.

       3.      Any person displaying behavior that would indicate they were under the influence of
               drugs or alcohol.

       4.      Any series of circumstances or behavior(s) that could reasonably be determined to pose
               an immediate threat to the health and/ or safety of enrolled individual(s) and/or staff of
               WCBDD.

B.     The person observing such activity will not intervene unless they are trained to do so, however
       they should try to remove any enrolled individuals from immediate danger if possible.

C.     Any staff in the immediate vicinity should be notified to aid in moving enrolled individuals to safe
       location(s) and the senior Director or Supervisor should be notified immediately.

D.     The senior Director/Supervisor/designee shall notify the appropriate authorities and the
       Superintendent/designee. The administrative assistant/designee shall contact staff as quickly as
       possible, utilizing the following facility paging code: “Would the custodian please bring the keys to
       the office”

       1.      This means: Staff should lock themselves and any enrolled individuals that may be with
               or near them in their classroom or office with the lights off and await further instructions.
               Individuals in the EI Playhouse should move to classroom #007. While remaining in their
               location, they should avoid windows and doors.

       2.      Upon receiving this message: “All staff please report to the scheduled in-service” all staff
               should proceed to evacuate the building quickly and quietly, following the fire evacuation
               procedure, making sure that any enrolled individuals in their area are aided and
               accounted for. They should await further instructions at their designated evacuation
               sites.

E.     If evacuation from the site is required, at the direction of the Superintendent/designee or
       Emergency personnel, DD Transportation shall be notified to transport enrolled individuals as
       needed. Evacuation to alternate sites would be:

       1.      PSU to Warren C. Young Center

       2.      Warren C. Young Center to PSU



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        3.      Milo H. Banta Center to County Administration Building

F.      Returning to regular activities:

        1. The administrative assistant/designee shall utilize the following Facility Paging Code to
           communicate an “all clear” condition

             a. “All meetings are cancelled”

This means that staff and enrolled individuals can return to normal activities (a code is utilized to minimize
the chances of someone being forced to announce an “all clear” and provide access for an intruder).


APPROVED:


                                                                                   March 26, 2010
          Megan K. Manuel, Superintendent                                              Date




                                    Violent or Threatening Situation – WCYC
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                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

FIRE EVACUATION - PSU                                                                          SECTION 2.30


PURPOSE:           To ensure safe evacuation of facilities in the event of a fire.

PROCEDURE:

A.       CONDUCTING FIRE DRILLS

     1. The facility director will implement a fire drill at least monthly. The director
        will instruct the administrative secretary or a designee to follow procedures below:

             a. Call Bellamy Alarm Company at 1-800-626-9364.
             b. Call WCBDD Transportation
             c. Call Fire Department at 932-6119
             d. Tell them this is a test for Account number- PSU 3852B
             e. Have stopwatch ready.
             f. To begin drill push 2, 0, enter, and code (1234) in keypad located at the front of each
                facility.
             g. Press stopwatch as alarm goes off.
             h. Follow evacuation plan.
             i. Push stopwatch to stop time.
             j. Reset alarm by pressing reset, enter and 1234.
             k. Call Bellamy back to make sure the alarm monitoring system is on line.
             l. Call WCBDD Transportation to inform drill is complete.
             m. Call Fire Department to inform drill is complete.

     2. The facility director/designee will complete a WCBDD Emergency Drill Documentation sheet and
        submit a copy to the Safety Chairperson at the Administration Office. The original sheet should
        be placed in the Emergency Drill Documentation book located in each facility.              The
        director/designee should note any recommendations regarding the drill and note any follow-up
        action taken as a result of the recommendation. The Safety Committee Chairperson shall review
        drill sheets for evidence of follow-up by monitoring for abnormalities and patterns of
        abnormalities. The Safety Committee Chairperson shall refer any such patterns to the Safety
        Committee for review and resolution.

     3. Drills will be scheduled at different times of the day. Occasionally, an exit will be deliberately
        blocked so that the staff and employees will be familiar with alternative routes.

     4. Refer to Employee Emergency and Fire Prevention Plan in the Exposure Control Plan book for
        additional information.

B.       EVACUATION - PRODUCTION SERVICES

     2. Employee/individual who suspects or discovers a fire shall activate the emergency pull station
        located closest to them. The locations of all pull stations are identified on the attached floor plan.

     3. At the sound of the alarm, the Secretary/designee will take the attendance roster (including all on
        premises individuals, staff and visitors) and the staff and enrolled individuals emergency medical
        authorization books and sign in/out clipboards out of the building.



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     4. Staff will assist individuals in evacuating the building in a calm, quiet manner by routes
        designated on maps located in each room. In case the primary routes are blocked in any way,
        the alternative exits will be used.

     5. It will be the responsibility of the custodial staff/designee to remove the MSDS book.

     6. All nurses are to bring first aid kits out of the building to each of the assembly areas during fire
        drills and to offer first aid to anyone in need during fire drills.

     7. Sector Chiefs/back-up should bring attendance roster to their evacuation area. As individuals
        report to the assigned area, the Sector Chief should mark the individual is accounted for. Sector
        Chiefs should assist in immediate first aid if necessary. Once everyone is accounted for, the
        Sector Chief should report to the Quadrant Chief.

     8. The Quadrant Chiefs will check their assigned areas of the building. Once the assigned area is
        clear, the Quadrant Chief should report to their evacuation area. Quadrant Chiefs should check
        with Sector Chiefs, ensure all individuals are accounted for and report their area all clear.

     9. In the event of an actual fire, the Facility Director/designee will report to the fire squad the number
        of enrolled individuals and staff (if any) that are believed to still be in the building.

     10. Staff/individuals will remain in their assigned evacuation sites until the Facility Director gives the
         All Clear.

     11. If the fire presents a continuing danger or the building is rendered no longer habitable, individuals
         will be evacuated to the designated safe area. The transportation manager will be contacted by
         the Facility Director/designee and arrangements made to transport the individuals to their homes.

C.       FIRE TRAINING/INSPECTION

     1. Annually, and as changes occur, staff will be trained on fire evacuation and drill procedures.
     2. Designated staff will be trained by the local fire chief/designee on proper fire suppression
        techniques.
     3. Annually, an inspection shall be requested of the local fire chief. The Facility Director will be
        responsible for ensuring this occurs.


APPROVED:


                                                                                    March 26, 2010
          Megan K. Manuel, Superintendent                                               Date




                                             Fire Evacuation – PSU
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               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

TORNADO DRILL - PSU                                                                          SECTION 2.31


PURPOSE:     To ensure the safety of enrolled individuals and staff of Adult Services in the event of a
tornado.

PROCEDURE:

A.    TORNADO WATCH

      1.     Adult Services will be alerted by a weather radio located in the front
             office. An announcement will be made that a tornado watch is in effect.

      2.     Announcements by the weather radio will be monitored by the front office staff.

      3.     Non-ambulatory individuals should get into their wheelchairs to be
             prepared for possible evacuation.

      4.     Individuals should continue programming and staff will review tornado
             plans with groups in anticipation of movement to designated areas.

      5.     The Administrative Secretary/Secretary at Production Services will alert
             individuals in the annex, who should then report to the main building.


B.    TORNADO WARNING

      1.     Upon notification of a tornado warning from the weather radio device in the
             front office, the Facility Director/designee will activate a long continuous
             warning signal with an air horn. An announcement will also be made notifying
             staff/individuals of the tornado warning.

      2.     All individuals will report to the designated evacuation area. Identified
             sector chiefs will report to their designated areas with their tornado kits.
             Sector chiefs will be responsible for taking attendance to account for all
             individuals.

      3.     The Administrative Secretary of each facility will collect all sign-in sheets
             and attendance rosters and take them to the Facility Director/designee.

      4.     Upon arrival to their designated areas, all individuals will assume shelter-
             body position as follows:

                     a. Sit on the floor facing interior wall
                     b. Head between knees
                     c. Place coat/blanket over head
                     c. Persons in wheelchairs will remain in their chairs

      5.   The Facility Director/Quadrant Chief will check with Sector Chiefs
            to ensure that everyone is in their assigned areas and accounted for.



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          6.     Injuries should be reported to the Nurses or Facility Director/designee.

          7.     Everyone should remain in his or her designated areas until an all clear is
                 sounded/announced by the Facility Director/designee.

C.        DRILLS

          1.   The Facility Director/designee will implement a tornado drill once a month
               during tornado season (April through August) or more frequently as
               determined by the Facility Director/designee.

          2.   The Facility Director/designee will instruct the Administrative Secretary or
               other designated staff person to proceed with the following:

                 a.   Get stopwatch and air horn or whistle.
                 b.   Announce the drill and blow horn or whistle into the loud speaker.
                 c.   Start the stopwatch to time the drill.
                 d.   Monitor drill by making sure everyone is in the appropriate tornado shelters.
                 e.   Once everyone is in, make sure there is at least one Disaster Kit in each area.
                 f.   Stop the watch for time.
                 g.   Announce “all clear.”

     3.        The Facility Director/designee will write Emergency Drill Documentation sheet and submit a
               copy to the Safety Chairperson, Administrative Secretary, Administration Office. The
               original sheet should be kept in the emergency drill binder in the reception area.

     4.        Any issues/concerns that arise as a result of the drill will be discussed with staff at the next
               staff meeting.

     5.        Refer to “Employee Emergency and Fire Prevention Plans” in the “Exposure Control Plan”
               book for additional information.

     6.        See attached information for specific staff assignments for each facility.



APPROVED:


                                                                                     March 26, 2010
           Megan K. Manuel, Superintendent                                               Date




                                              Tornado Drill – PSU
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                                                                                                  Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

POWER FAILURE - PSU                                                                        SECTION 2.32


PURPOSE:       To ensure safety of enrolled individuals/staff of Adult Services in the event of a power
    failure.

PROCEDURE:

A.   POWER FAILURE

     1. The facility will remain status quo until the power company either remedies the situation, or the
        Superintendent or designee deems it to be in the best interest of the enrolled individuals to
        close the facility.

     2. If the facility is to be closed, the Superintendent or Designee will notify the transportation
        division and arrange to have individuals transported home.

B.   LIGHTING

     1. Emergency back up lighting is located throughout the building.

     2. Battery-powered emergency lighting will be tested once a month by the facility maintenance
        representative and once quarterly during the internal inspection.

C.   FIRE ALARM SYSTEM

     1. The fire alarm system also has a battery operated back up power source in the event of a
        power failure.

           a. The alarm company representative will test the emergency back up yearly.




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                           Power Failure – PSU
                                              Page 1 of 1
                                                                                                 Effective 03/10




                WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                               AGENCY PROCEDURE

BOMB THREAT - PSU                                                                        SECTION 2.33


PURPOSE:      To ensure the safety of all enrolled individuals/staff in the event of a bomb threat.

PROCEDURE:

A.   UNUSUAL ACTIVITY

     1. Staff should report any unusual circumstances, persons, or objects in the building or
        surrounding area, to the Director/designee.

     2. If deemed necessary, the Director/designee should evacuate the facility. See “C. Notifying
         Director.”

B.   WHEN BOMB THREAT IS RECEIVED

     1. Keep caller on the line as long as possible
     2. Do not hang up or disconnect the line
     3. Direct other personnel to call the operator and request an emergency trace stating “We
           have a BOMB THREAT.”
     4. Other       personnel (secretary, Director, etc…) should contact Warren County
           Telecommunications (ext. 1320) and tell them that there has been a bomb threat. Report
           which line the caller is on and ask that the line be traced.
     5. Attempt to gain the following information:
              a. location of the bomb
              b. time of detonation
              c. name of caller
              d. identifying characteristics of caller’s voice

C.   NOTIFYING DIRECTOR

     1. The Director/designee will activate the fire alarm and evacuate the building immediately.

     2. The Director should immediately inform the Lebanon Police/Fire
        Department of the bomb threat.

     3. Once the safety of all persons is ensured, the Superintendent will then be notified. If the
        building cannot be re-entered the Superintendent or designee will notify the transportation
        division and arrange to have individuals transported home or the emergency evacuation site
        (WCYC).
     4. Staff will remain until all individuals have been picked up.




                                          Bomb Threat – PSU
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     5. No person will be permitted to enter the building until it has been declared safe by the
        Superintendent or Director/designee.

     6.    If evacuation occurs during inclement weather, staff should assist individuals to the
          emergency evacuation site. The site for Production Services Unlimited is WCYC.



APPROVED:


                                                                        March 26, 2010
      Megan K. Manuel, Superintendent                                       Date




                                      Bomb Threat – PSU
                                         Page 2 of 2
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                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

EARTHQUAKE EMERGENCY - PSU                                                                 SECTION 2.34


PURPOSE:       To ensure the safety of all enrolled individuals/staff of PSU in the event of an earthquake.

PROCEDURE:

A.        IF INDOORS DURING AN EARTHQUAKE

          1.   When you feel an earthquake, all individuals should be relocated to a tornado shelter,
               individuals using wheelchairs should be positioned as close as possible to supporting
               walls. All other persons should move or stay away from windows, file cabinets,
               bookcases, heavy mirrors, hanging objects, or ceiling tiles. Stay under cover until the
               shaking stops.

          2.   When it is believed safe, the Ranking Administrator or designee will initiate evacuation of
               the area by using the FIRE EVACUATION PROCEDURE.

          3.   Maintenance staff or designee should be notified to secure and shut off the utilities to the
               building, following emergency shout off procedure.


B.   IF OUTDOORS DURING AN EARTHQUAKE

          1.   Do not enter the building. Proceed to the closest FIRE EVACUATION waiting area.

          2.   Move away from all structures, utility poles, downed power lines, trees and signs.

          3.   If you are driving pull over to the side of the road and stop. Avoid overpasses, power
               lines and other hazards. Stay inside the vehicle until the shaking stops.

C.   AFTER THE EARTHQUAKE STOPS

          1.   The Adult Services Director, Facility Director, Safety Chairperson or designee will assure
               that all participants and employees are accounted for. A list of any missing persons and
               their possible whereabouts will be compiled.

     2.        The nurse will coordinate the assessment of any injuries and will be assisted by the first
               aid team. The nurse or designee will report to the Adult Services Director, Facility
               Director, or designee, who will arrange to call the EMERGENCY SQUAD if anything other
               than routine FIRST AID is required.

     3.        The Adult Services Director, Facility Director, or designee will report any missing persons
               to the Lebanon Fire Department.

     4.        If the facility is to be closed, transportation will be notified and individuals will be
               evacuated to their homes or the emergency evacuation site (WCYC).




                                      Earthquake Emergency - PSU
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                                                                              Effective 03/10




APPROVED:


                                                             March 26, 2010
      Megan K. Manuel, Superintendent                            Date




                                Earthquake Emergency - PSU
                                        Page 2 of 2
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

TOXIC SPILL - PSU                                                                             SECTION 2.35


PURPOSE: To ensure the safety of enrolled individuals/staff of Adult Services in the event of a toxic spill.

PROCEDURE:

A.    Hazardous material spills include the release of sudden discharge in harmful or
      reportable quantities of:

      1.    Oil or other petroleum products

      2.    Hazardous waste that may be hazardous or detrimental to:

            a. Surface or ground water
            b. Air quality
            c. Surrounding land and fixtures (trees, shrubs, etc.)

      3.   Hazardous materials include:

            a.   Explosives
            b.   Flammable liquids
            c.   Water reactive substances
            d.   Oxidizing materials
            e.   Poisonous or toxic materials
            f.   Radioactive materials
            g.   Corrosive materials

      4. A material is considered hazardous material if:

            a. Specifically listed in the law, 29 CFR part 1910, subpart Z, Toxic and Hazardous
               Substances (Z List).
            b. Assigned a threshold limit value (TLV) by the American Conference of Governmental
               Industrial Hygienist, Inc. (ACGIH).
            c. Determined to be cancer causing, corrosive, toxic, an irritant, a sensitizer, or has a
               damaging effect of specific body organs.

B.    All spills or potential spills must be reported immediately, including the following:

      1.   Chemical spills
      2.   Accidents involving chemicals with potential spills
      3.   Fires with chemicals involved
      4.   Fuel tank delivery overfills
      5.   Oil spills where product enters a watercourse

C.    Encountering a spill and what to do

      1. All spills must be reported to the Adult Services Director, Facility Director, designee or safety
         chairperson.
      2. Without endangering yourself or others, try to stop the flow of hazardous materials and prevent
         the spill from spreading.


                                                Toxic Spill – PSU
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     3. ONLY TRAINED PERSONNEL WILL BE PERMITTED IN THE AREA TO CLEAN UP THE
        SPILL!
     4. The law requires the person having the spill to report the spill. If you know about it, you MUST
        REPORT IT IMMEDIATELY!
D.   When reporting a spill give the following information:

     1.   Name of person reporting the spill
     2.   Location of spill
     3.   Material involved
     4.   Estimated volume
     5.   Whether source is controlled
     6.   Whether a water source in involved

E.   Internal toxic spill (spill occurring inside facility), the facility manager will initiate the following:

     1. Evacuate all individuals from the facility utilizing the fire evacuation procedure.
     2. Immediately notify the Local Fire Department. Adult Services Director, Facility Director or
         designee who will call 911 and ask to have the Haz Mat coordinator
        dispatched to the site (932-4080).
     3. Provide all the information to each as identified in Spill Report Information as listed in this
         procedure.
     4. FOLLOW SAFETY OFFICIALS RECOMMENDATIONS.
     5. If the facility is to be closed, the Superintendent or designee will notify the transportation
         division and arrange to have participants transported home.
     6. No individual may reenter the facility until the local authorities give the “all clear”.

F.   External toxic spills (spills occurring outside a facility), the Adult Services
     Director, Facility Director, designee or Safety Chairperson will initiate the
     following:

     1. Immediately notify the Local Fire Department, Environmental Protection Agency, Adult Services
        Director, Facility Director or designee and provide all the information to each as identified in
        SPILL REPORT FORM as listed in this procedure.

     2. If the facility is to be closed, the Superintendent or designee will notify the transportation
        division and arrange to have participants transported home or to the emergency evacuation site
        (WCYC).



APPROVED:


                                                                                         March 26, 2010
          Megan K. Manuel, Superintendent                                                    Date




                                                 Toxic Spill – PSU
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                                                                                                 Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

VIOLENT OR THREATENING SITUATION - PSU                                                     SECTION 2.36


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a violent or threatening situation.

PROCEDURE:

    A.      Immediately upon recognition of a violent or threatening situation on or near DD property
            such as, but not limited to:

            1. Any person in possession of a deadly weapon
            2. Any person observed in a violent or threatening act or behavior
            3. Any person displaying behavior that would indicate they were under the influence of
               drugs or alcohol
            4. Any series of circumstances or behavior(s) that could reasonably be determined to pose
               an immediate threat to the health and/ or safety of enrolled individual(s) and/or staff of
               WCBDD

    B.      The person observing such activity will not intervene unless they are trained to do so,
            however they should try to remove any enrolled individuals from immediate danger if
            possible.

    C.      Any staff in the immediate vicinity should be notified to aid in moving enrolled individuals to
            safe location(s) and the senior Director or Supervisor should be notified immediately.

    D.      The senior Director/Supervisor/designee shall notify the appropriate authorities and the
            Superintendent/designee. The administrative assistant /designee shall contact staff as
            quickly as possible, utilizing the following Facility Paging Code:

            1. “Would the custodian please bring the keys to the office?”
            This means all staff should lock themselves and any enrolled individuals that may be with or
            near them in their classroom, office, SCU, or Hab unit with the lights off and await further
            instructions. While remaining in their locations, they should avoid windows and doors as
            much as possible.

            2. “All available staff please report to the scheduled in-services”
            Upon receiving this message, all staff should proceed to evacuate the facility quickly and
            quietly, following the fire evacuation procedure, making sure that any enrolled individuals in
            their area are aided and accounted for. They should await further instructions at their
            designated evacuation sites.


    E.      If evacuation from the site is required, at the direction of the Superintendent/designee or
            Emergency personnel, DD Transportation shall be notified to transport enrolled individuals as
            needed. Evacuation to alternate sites would be:

            1. PSU to Warren C. Young Center
            2. Warren C. Young Center to PSU
            3. Milo H. Banta Center to County Administration Building

Returning to Regular Activities:
                                   Violent or Threatening Situation – PSU
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The administrative assistant/designee shall utilize the following Facility Paging Code to communicate an
“all clear” condition:

             “All meetings are cancelled.”

This means that staff and enrolled individuals can return to normal activities (a code is utilized to minimize
the risks of someone being forced to announce an “all clear” and providing access to an intruder.)



APPROVED:


                                                                                   March 26, 2010
            Megan K. Manuel, Superintendent                                            Date




                                    Violent or Threatening Situation – PSU
                                                  Page 2 of 2
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EMERGENCY EVACUATION – MILO H. BANTA CENTER                                                SECTION 2.37


PURPOSE: To ensure the safe and efficient evacuation of family members, individuals, and the public
and staff in the Milo H. Banta Center during emergency situations.

PROCEDURE:

A.     FIRE EVACUATION

           AT THE SOUND OF THE FIRE ALARM:

           1. Staff members shall assume responsibility for the evacuation of person(s) in his/her
              office. This staff member shall assign additional staff to assist person(s) to designated
              evacuation areas as needed.

           2. Staff in each area shall shut windows; turn off electrical appliances and lights, and close
              door upon leaving room.

           3.    All occupants shall proceed to the evacuation sites as indicated on the building map in
                each room.

           4. Secretary or designee shall contact authorities and notify them of the emergency.
              Secretary or designee shall ensure that all office lights and equipment are turned off.

           5. Unassigned staff may be directed to assist with evacuation as needed.

           6. Ranking Division personnel shall verify that all persons in his/her Division have been
              evacuated and remain with the group.

           7. Ranking Division Personnel shall report to the Superintendent/designee that everyone is
              accounted for.

           8. Persons and staff are to remain in designated area until “all clear” signal is given.

           9. Fire drills shall be conducted monthly. Director/designee shall time the drill and complete
              the WCBMR/DD Drill Documentation Sheet (AGF-007).             All drills shall be practiced
              according to the procedure and documented by the person(s) conducting the drill,
              including the time elapsed to reach evacuation sites during the drill and a written analysis
              of the conduct and effectiveness of the drill as well as any follow-up completed or
              recommended. This documentation shall be kept on site at the reception desk and a
              copy forwarded to the Chairman of the Safety Committee for review and follow up.


B.     TORNADO EVACUATION

       TORNADO WATCH:

       Definition: An alert or forecast issued when conditions are favorable for the development of
       severe weather or tornadoes.




                               Emergency Evacuation – Milo H. Banta Center
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          1. An emergency weather radio shall be maintained in the Superintendent’s office and
             monitored by the Administration Secretary or designee.

          2. Administration Secretary or designee shall notify all MR/DD staff when a tornado watch is
             in effect.

     TORNADO WARNING:

     Definition: A warning of danger issued when a tornado has been sighted and protective
     measures should be taken in the immediate vicinity.

          1. An emergency weather radio shall be maintained in the Superintendent’s office and
             monitored by the Administration Secretary or designee.

          2. Administration Secretary or designee shall notify all MR/DD staff when a tornado warning
             is in effect by activating the tornado siren.

          3. Available staff may be asked to report to assist individuals in evacuation as needed.

          4. Staff shall assist persons to the designated shelter area. Persons shall remain in
             wheelchairs. Staff shall ensure that all persons are accounted for.

          5. All occupants shall proceed to the shelter areas indicated on the building map in each
             room.

          6. All staff and persons shall remain in the shelter area until the all-clear signal is given.

          7. If there is insufficient warning time for staff and persons to reach the shelter area, they
             shall move to the inside wall of the classroom.

          8. Tornado drills shall be conducted in April through August each year. Director/designee
             shall time the drill and complete the WCBMR/DD Drill Documentation Sheet (AGF-007).
             All drills shall be practiced according to the procedure and documented by the person(s)
             conducting the drill, including the time elapsed to reach shelter during the drill and a
             written analysis of the conduct and effectiveness of the drill as well as any follow-up
             completed or recommended. This documentation shall be kept on site and a copy
             forwarded to the Chairman of the Safety Committee for review and follow up.

C.   EARTHQUAKE

     1.       IF INDOORS DURING AN EARTHQUAKE

                    a. When you feel an earthquake, all individuals should be relocated to a tornado
                       shelter, individuals using wheelchairs should be positioned as close as
                       possible to supporting walls. All other persons should move or stay away from
                       windows, file cabinets, bookcases, heavy mirrors, hanging objects, or ceiling
                       tiles. Stay under cover until shaking stops.

                    b. When it is believed safe, the Ranking Administrator or designee will initiate
                       evacuation of the area by using the fire evacuation procedure.

                    c.   Maintenance staff or designee will secure and shut off the utilities to the
                         building following emergency shut off procedure.


     2.       IF OUTDOORS DURING AN EARTHQUAKE

                              Emergency Evacuation – Milo H. Banta Center
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                 d. Do not enter the building. Proceed to the closest FIRE EVACUATION waiting
                    area.

                 e. Move away from all structures, utility poles, downed power lines, trees, and
                    signs.

                 f.   If you are driving, pull over to the side of the road and stop. Avoid overpasses,
                      power lines, and other hazards. Stay inside the vehicle until the shaking stops.

       AFTER THE EARTHQUAKE STOPS

                 g. The Senior Administrative staff on site or designee will assure that all persons
                    are accounted for. A list of any missing persons and their possible
                    whereabouts will be compiled.

                 h. The Senior Administrative staff or designee will coordinate the assessment of
                    any injuries and will be assisted by the first aid team. A nurse or designee will
                    report to the Senior Administrative staff on site or designee, who will arrange to
                    call the EMERGENCY SQUAD if anything other than routine FIRST AID is
                    required.

                 i.   The Senior Administrative staff on site or designee will report any missing
                      persons to the Lebanon Fire Department.

                 j.   If the facility is to be closed, transportation will be notified and individuals will
                      be evacuated to their homes or the emergency evacuation site (WCYC).

D.   BOMB THREAT EVACUATION

       1. All staff shall report any unusual circumstances, persons, or objects in the building or
          grounds to the Superintendent/designee.

       2. When a bomb threat is received:
          a. Keep the caller on the line as long as possible.
          b. Do not hang up and disconnect the line.
          c. Attempt to gain the following information:
             1. Location of bomb
             2. Time of detonation
             3. Name of caller
             4. Identifying characteristics of caller’s voice
          d. Direct another staff to call the local operator and request an emergency trace stating,
             “We have a bomb threat”.
          e. Notify the Superintendent/designee

       3. The Superintendent/designee shall activate the fire alarm to begin emergency evacuation
          procedure (see fire evacuation procedure) and move everyone to the far end of the
          parking area.

       4. The Superintendent/designee shall call 911 to notify the Lebanon Police Department of
          the bomb threat.

       5. After the building has been safely evacuated, the Superintendent’s/designee shall notify
          the Superintendent.

       6. Staff shall remain with persons until all persons have been picked up.

                           Emergency Evacuation – Milo H. Banta Center
                                         Page 3 of 4
                                                                                                Effective 03/10




         7. No person shall be permitted to reenter the building until it has been declared safe by the
            Superintendent/Designee.




E.   TOXIC SPILL

     Definition: Toxic spills involve the release of hazardous material in reportable quantities into the
     environment. These hazardous materials may include explosives, flammable liquids, water
     reactive substances, oxidizing materials, poisonous materials, radioactive materials, and
     corrosive materials.


     INTERNAL TOXIC SPILL

         1. All spills or potential spills shall be reported to the superintendent/designee immediately.

         2. When reporting a spill the following shall be included:
            a. Name of person reporting.
            b. Location of spill
            c. Hazardous material involved.
            d. Estimated volume
            e. Whether the source is controlled
            f. Whether a water source is involved

         3. Staff shall attempt to control the spill to the extent they are able without endangering
            themselves.

         4. If the spill cannot be controlled, the Superintendent/designee shall activate the fire alarm
            to begin emergency evacuation procedure (see fire evacuation procedure and move
            everyone to the far end of the parking area.

         5. The Receptionist/designee shall notify the local fire department and/or environment
            protection agency of the spill.

         6. After the building has been safely evacuated, the Superintendent’s/designee shall notify
            the Superintendent when applicable.

         7. Staff shall remain with persons until all persons have been picked up.

         8. No person shall be permitted to reenter the building until it has been declared safe by the
            Superintendent or Designee.

     EXTERNAL TOXIC SPILLS

     When local authorities notify the Superintendent/designee of a toxic spill in the area, he/she shall
     implement the action recommended by the local authorities.

F.   POWER FAILURE

         1. During a power failure, staff and persons shall remain in assigned areas with alterative
            light source (e.g. windows) and complete tasks not requiring electricity. Office staff shall
            move to areas with alternative light source and complete tasks not requiring electricity.



                             Emergency Evacuation – Milo H. Banta Center
                                           Page 4 of 4
                                                                                           Effective 03/10




        2. Flashlights shall be available for use in areas with no alternative light source (e.g.
           bathrooms).

        3. Office computers shall be turned off to prevent damage.

        4. The division secretary/designee shall contact the appropriate authorities and notify them
           of the power failure.

        5. The superintendent/designee shall determine if it is necessary to close the program and
           arrange to have persons transported home.



APPROVED:


                                                                          March 26, 2010
      Megan K. Manuel, Superintendent                                         Date




                           Emergency Evacuation – Milo H. Banta Center
                                         Page 5 of 4
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

VIOLENT OR THREATENING SITUATION - MHBC                                                   SECTION 2.38


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a violent or threatening situation

PROCEDURE:

A.     Immediately upon recognition of a violent or threatening situation on or near DD property such as,
       but not limited to:

           1. Any person in possession of a deadly weapon
           2. Any person observed in a violent or threatening act or behavior
           3. Any person displaying behavior that would indicate they were under the influence of
              drugs or alcohol
           4. Any series of circumstances or behavior(s) that could reasonably be determined to pose
              an immediate threat to the health and/ or safety of enrolled individual(s) and/or staff of
              WCBDD

B.     The person observing such activity will not intervene unless they are trained to do so, however
       they should try to remove any enrolled individuals from immediate danger if possible.

C.     Any staff in the immediate vicinity should be notified to aid in moving enrolled individuals to safe
       location(s) and the superintendent and directors should be notified immediately.

D.     The superintendent or designee shall notify the appropriate authorities. The administrative
       assistant /designee shall contact staff as quickly as possible, utilizing the phone system or by
       sending an individual to notify everyone.

E.     All staff should lock themselves and any enrolled individuals that may be with or near them in
       their immediate office area with the lights off, doors locked, and await further instructions. While
       remaining in their location, they should avoid windows and doors.

           1. If directed by the superintendent/superintendent designee to evacuate the building, all
              staff should proceed to evacuate the facility quickly and quietly, following the fire
              evacuation procedure, making sure that any enrolled individuals in their area are aided
              and accounted for. They should await further instructions at their designated evacuation
              sites.




                                  Violent or Threatening Situation – MHBC
                                                 Page 1 of 2
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        2. If evacuation from the site is required, at the direction of the Superintendent/designee or
           Emergency personnel, DD Transportation shall be notified to transport enrolled
           individuals as needed. Evacuation to alternate site would be:

            a.      Milo H. Banta Center to County Administration Building (406 Justice Drive)



APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                              Violent or Threatening Situation – MHBC
                                             Page 2 of 2
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

VIOLENT OR THREATENING SITUATION – DEERFIELD CENTER                                        SECTION 2.39
SSA/ADULT SERVICES

PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a violent or threatening situation

PROCEDURE:

A.     Immediately upon recognition of a violent or threatening situation on or near DD property such as,
       but not limited to:

           1. Any person in possession of a deadly weapon
           2. Any person observed in a violent or threatening act or behavior
           3. Any person displaying behavior that would indicate they were under the influence of
              drugs or alcohol
           4. Any series of circumstances or behavior(s) that could reasonably be determined to pose
              an immediate threat to the health and/ or safety of enrolled individual(s) and/or staff of
              WCBDD

B.     The person observing such activity will not intervene unless they are trained to do so, however
       they should try to remove any enrolled individuals from immediate danger if possible.

C.     Any staff in the immediate vicinity should be notified to aid in moving enrolled individuals to safe
       location(s) and the superintendent and directors should be notified immediately.

D.     The superintendent or designee shall notify the appropriate authorities. The administrative
       assistant /designee shall contact staff as quickly as possible, utilizing the phone system or by
       sending an individual to notify everyone.

E.     All staff should lock themselves and any enrolled individuals that may be with or near them in
       their immediate office area with the lights off, doors locked, and await further instructions. While
       remaining in their location, they should avoid windows and doors.

           1. If directed by the superintendent/superintendent designee to evacuate the building, all
              staff should proceed to evacuate the facility quickly and quietly, following the fire
              evacuation routes posted in each room, making sure that any enrolled individuals in their
              area are aided and accounted for. They should await further instructions at their
              designated evacuation sites.




                             Violent or Threatening Situation –Deerfield Center
                                                Page 1 of 2
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        2. If evacuation from the site is required, at the direction of the Superintendent/designee or
           Emergency personnel, DD Transportation shall be notified to transport enrolled
           individuals as needed. Evacuation to alternate site would be:

            a.      Deerfield Center to Production Services


APPROVED:


                                                                               March 26, 2010
      Megan K. Manuel, Superintendent                                              Date




                          Violent or Threatening Situation –Deerfield Center
                                             Page 2 of 2
                                                                                                  Effective 03/10




                    WARREN COUNTY BOARD DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EMERGENCY EVACUATION – DEERFIELD CENTER                                                    SECTION 2.40
SSA/ADULT SERVICES DIVISIONS

PURPOSE: To ensure the sage and efficient evacuation of family members, individuals, the public
and staff in the Deerfield Center during emergency situations.

PROCEDURE:

A.     FIRE EVACUATION

           AT THE SOUND OF THE FIRE ALARM:

           1. Staff members shall assume responsibility for the evacuation of person(s) in his/her
              office. This staff member shall assign additional staff to assist person(s) to designated
              evacuation areas as needed.

           2. Staff in each area shall shut windows; turn off electrical appliances and lights, and close
              door upon leaving room.

           3.    All occupants shall proceed to the evacuation sites as indicated on the building map in
                each room.

           4. Occupants leaving the front building via the front exit shall proceed to the area of the
              parking lot by the sign. Occupants exiting either building via the rear exits shall proceed
              to the north end of the parking area between the buildings. Occupants exiting the rear
              building via the north or east exits shall proceed to the northeast area of the parking lot.

           5. Secretary or designee shall call 911 and notify them of the emergency. Secretary or
              designee shall ensure that all office lights and equipment are turned off.

           6. Unassigned staff may be directed to assist with evacuation as needed.

           7. Ranking Division personnel shall verify that all persons in his/her Division have been
              evacuated and remain with the group.

           8. Ranking Division Personnel shall report to the Director/designee that everyone is
              accounted for.

           9. Persons and staff are to remain in designated area until “all clear” signal is given.

           10. Evacuation to alternative site would be PSU.

           11. Fire drills shall be conducted monthly. Director/designee shall time the drill and complete
               the WCBDD Drill Documentation Sheet (AGF-007). All drills shall be practiced according
               to the procedure and documented by the person(s) conducting the drill, including the time
               elapsed to reach evacuation sites during the drill and a written analysis of the conduct
               and effectiveness of the drill as well as any follow-up completed or recommended. This
               documentation shall be kept on site at the reception desk and a copy forwarded to the
               Chairman of the Safety Committee for review and follow up.


B.     TORNADO EVACUATION


                                 Emergency Evacuation –Deerfield Center
                                             Page 1 of 5
                                                                                                 Effective 03/10




     TORNADO WATCH:

     Definition: An alert or forecast issued when conditions are favorable for the development of
     severe weather or tornadoes.

        1. An emergency weather radio shall be maintained in the Division Secretary’s office and
           monitored by the Secretary or designee.

        2. The Division Secretary or designee shall notify all DD staff when a tornado watch is in
           effect.

     TORNADO WARNING:

     Definition: A warning of danger issued when a tornado has been sighted and protective
     measures should be taken in the immediate vicinity.

        1. An emergency weather radio shall be maintained in the Division Secretary’s office and
           monitored by the Secretary or designee.

        2. The Division Secretary or designee shall notify all DD staff when a tornado warning is in
           effect by activating the air horn.

        3. Available staff may be asked to report to assist individuals in evacuation as needed.

        4. Staff shall assist persons to the designated shelter area. Persons shall remain in
           wheelchairs. Staff shall ensure that all persons are accounted for and report to Division
           Director/Designee that everyone is accounted for.

        5. All occupants shall proceed to the shelter areas indicated on the building map in each
           room. Staff should bring the Emergency Kit from their area to the tornado shelter area.

        6. All staff and persons shall remain in the shelter area until the all-clear signal is given.

        7. If there is insufficient warning time for staff and persons to reach the shelter area, they
           shall move to the inside wall of the area they are in.

        8. Evacuation to alternative site PSU.

        9. Tornado drills shall be conducted in April through August each year. Director/designee
           shall time the drill and complete the WCBDD Drill Documentation Sheet (AGF-007). All
           drills shall be practiced according to the procedure and documented by the person(s)
           conducting the drill, including the time elapsed to reach shelter during the drill and a
           written analysis of the conduct and effectiveness of the drill as well as any follow-up
           completed or recommended. This documentation shall be kept on site and a copy
           forwarded to the Chairman of the Safety Committee for review and follow up.

C.   EARTHQUAKE

        1. If indoors during an earthquake
           a. If an earthquake tremor is detected assist persons to a clear area away from
                windows, file cabinets, bookcases, etc. Persons should remain in wheelchairs.
           b. After tremor stops, evacuate persons to the assigned tornado shelter (see tornado
                evacuation procedure).
           c. When it is determined to be safe, the Director/designee shall initiate building
                evacuation (see fire evacuation procedure).

                               Emergency Evacuation –Deerfield Center
                                           Page 2 of 5
                                                                                                      Effective 03/10




                  d. The Director/designee shall secure and shut off all building utilities.

              2. If outdoors during an earthquake:
                 a. Do not enter the building. Proceed to the far end of the parking area.
                 b. Move away from all structures, utility poles, trees, etc.

              3. No person shall be permitted to reenter the building until it has been declared safe by the
                 Director/designee.

     D.   BOMB THREAT EVACUATION

              1. All staff shall report any unusual circumstances, persons, or objects in the building or
                 grounds to the Director/designee.

              2. When a bomb threat is received:
                 a. Keep the caller on the line as long as possible.
                 b. Do not hang up and disconnect the line.
                 c. Attempt to gain the following information:
                    1. Location of bomb
                    2. Time of detonation
                    3. Name of caller
                    4. Identifying characteristics of caller’s voice
                 d. Direct another staff to call the local operator and request an emergency trace stating,
                    “We have a bomb threat”.
                 e. Notify the Director/designee

              3. The Director/designee shall activate the fire alarm to begin emergency evacuation (follow
                 fire evacuation procedure). Ranking Division Personnel shall verify that all persons in
                 their Division are accounted for and report that to the Division Director/Designee.

              4. The Director/designee shall call 911 to notify the Lebanon Police Department of the bomb
                 threat.

              5. After the building has been safely evacuated, the Director/designee shall notify the
                 Superintendent.

              6. Staff shall remain with persons served they all have been picked up.

              7. No person shall be permitted to reenter the building until it has been declared safe by the
                 Director/Designee.

              8. Evacuation to alternative site would be PSU.

E.        TOXIC SPILL

          Definition: Toxic spills involve the release of hazardous material in reportable quantities into the
          environment. These hazardous materials may include explosives, flammable liquids, water
          reactive substances, oxidizing materials, poisonous materials, radioactive materials, and
          corrosive materials.


          INTERNAL TOXIC SPILL

              1. All spills or potential spills shall be reported to the Director/designee immediately.

              2. When reporting a spill the following shall be included:

                                    Emergency Evacuation –Deerfield Center
                                                Page 3 of 5
                                                                                                Effective 03/10




            a.   Name of person reporting.
            b.   Location of spill
            c.   Hazardous material involved.
            d.   Estimated volume
            e.   Whether the source is controlled
            f.   Whether a water source is involved

        3. Staff shall attempt to control the spill to the extent they are able without endangering
           themselves.

        4. If the spill cannot be controlled, the Director/designee shall activate the fire alarm to begin
           emergency evacuation procedure (follow fire evacuation procedure).

        5. The Division Secretary/designee shall notify the local fire department and/or environment
           protection agency of the spill.

        6. After the building has been safely evacuated, the Director/designee shall notify the
           Superintendent when applicable.

        7. Staff shall remain with persons until all persons have been picked up.

        8. No person shall be permitted to reenter the building until it has been declared safe by the
           Director or Designee.

        9. Evacuation to alternative site would be Deerfield Center to PSU.

     EXTERNAL TOXIC SPILLS

     When local authorities notify the Director/designee of a toxic spill in the area, he/she shall
     implement the action recommended by the local authorities.

F.   POWER FAILURE

        1. During a power failure, staff and persons shall remain in assigned areas with alterative
           light source (e.g. windows) and complete tasks not requiring electricity. Office staff shall
           move to areas with alternative light source and complete tasks not requiring electricity.

        2. Flashlights shall be available for use in areas with no alternative light source (e.g.
           bathrooms).

        3. Office computers shall be turned off to prevent damage.

        4. The division secretary/designee shall contact the appropriate authorities and notify them
           of the power failure.

        5. The superintendent/designee shall determine if it is necessary to close the program and
           arrange to have persons transported home.

        6. Evacuation to alternative site would be Deerfield Center to PSU.




APPROVED:




                               Emergency Evacuation –Deerfield Center
                                           Page 4 of 5
                                                                                Effective 03/10




                                                               March 26, 2010
Megan K. Manuel, Superintendent                                    Date




                      Emergency Evacuation –Deerfield Center
                                  Page 5 of 5
                                                                                                    Effective 03/10




                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

FIRE EVACUATION/FIRE DRILLS – DEERFIELD CENTER                                               SECTION 2.41


PURPOSE: To ensure safe evacuation of facilities in the event of a fire.

PROCEDURE:

A.       CONDUCTING FIRE DRILLS:
         Front Building

     1. The SSA Director will implement a fire drill at least monthly. The director will instruct their
        administrative secretary or a designee to follow procedures below:

             a. Call Bellamy Alarm Company at 1-800-626-9364
             b. Call WCBDD Transportation at 228-4025
             c. Call Fire Department at 932-2010
             d. Tell them this is a test for Account number- 8354-B
             e. Have stopwatch ready
             f. To begin drill push 2, 0, enter and code (1234) in keypad located at the front of each
                facility.
             g. Press stopwatch as alarm goes off.
             h. Follow evacuation plan
             i. Push stopwatch to stop time
             j. Reset alarm by pressing reset, enter and 1234
             k. Call Bellamy back to make sure the alarm monitoring system is on line
             l. Call WCBDD Transportation to inform drill is complete
             m. Call Fire Department to inform drill is complete.

     2. The facility director/designee will complete a WCBDD Emergency Drill Documentation sheet and
        submit a copy to the Safety Chairperson at the Administration Office. The original sheet should
        be placed in the Emergency Drill Documentation book located in each facility.              The
        director/designee should note any recommendations regarding the drill and note any follow-up
        action taken as a result of the recommendation. The Safety Committee Chairperson shall review
        drill sheets for evidence of follow-up by monitoring for abnormalities and patterns of
        abnormalities. The Safety Committee Chairperson shall refer any such patterns to the Safety
        Committee for review and resolution.

     3. Drills will be scheduled at different times of the day. Occasionally, an exit will be deliberately
        blocked so that the staff and employees will be familiar with alternative routes.

B.       EVACUATION – Deerfield Center – Front Building

     1. Employee/individual who suspects or discovers a fire shall activate the emergency pull station
        located closest to them. The locations of all pull stations are identified on the attached floor plan.
        Floor Plans are posted in all areas of the building.

     2. All building occupants shall exit following the posted evacuation routes to their designated
        assembly point at the side of the parking lot nearest Deerfield Road.

     3. At the sound of the alarm, the Division Secretaries/designees will take the attendance roster
        (including all on premises individuals, staff and visitors) and the staff and any enrolled individuals
        emergency medical authorization books and sign in/out clipboards out of the building.


                                  Fire Evacuation/Fire Drills – Deerfield Center
                                                  Page 1 of 3
                                                                                                       Effective 03/10




     4. Secretarial staff shall bring a first aid kit from their area to their designated assembly point.

     5. Staff will assist individuals in evacuating the building in a calm, quiet manner by routes
        designated on maps located in each room. In case the primary routes are blocked in any way,
        the alternative exits will be used.

     6. Division Directors/designees will check their assigned areas of the building. Once the assigned
        area is clear, the Division Directors/designees should report to their evacuation area.

     7. In the event of an actual fire, the Division Directors/designees will report to the fire squad the
        number of individuals (if any) who are believed to still be in the building.

     8. Staff/individuals will remain in the assigned evacuation site until the “All Clear” is given by their
        Division Directors/designees.

     9. If the fire presents a continuing danger or the building is rendered no longer habitable, individuals
        will be evacuated to the Production Services building. DD Transportation will be contacted by the
        Division Director/designee and arrangements made to transport any enrolled individuals to their
        homes.

C.       EVACUATION – Deerfield Center – Back Building

1.       The Adult Services Asst. Director will implement a fire drill at least monthly. The asst. director will
         instruct their division secretary or a designee to follow the procedures below:

             a.   Call Bellamy Alarm Company at 1-800-626-9364
             b.   Call WCBDD Transportation at 228-4025
             c.   Call Fire Department at 932-2010
             d.   Tell them this is a test for Account number- 8362-B
             e.   Have stopwatch ready
             f.   To begin drill follow instructions located in Fire Enunciator Panel near main entry doors.
             g.   Press stopwatch as alarm goes off.
             h.   Follow evacuation plan
             i.   Push stopwatch to stop time
             j.   Reset alarm by following instructions on the panel
             k.   Call Bellamy back to make sure the alarm monitoring system is on line
             l.   Call WCBDD Transportation to inform drill is complete
             m.   Call Fire Department to inform drill is complete.

     3. The facility director/designee will complete a WCBDD Emergency Drill Documentation sheet and
        submit a copy to the Safety Chairperson at the Administration Office. The original sheet should
        be placed in the Emergency Drill Documentation book located in each facility.              The
        director/designee should note any recommendations regarding the drill and note any follow-up
        action taken as a result of the recommendation. The Safety Committee Chairperson shall review
        drill sheets for evidence of follow-up by monitoring for abnormalities and patterns of
        abnormalities. The Safety Committee Chairperson shall refer any such patterns to the Safety
        Committee for review and resolution.

     4. Drills will be scheduled at different times of the day. Occasionally, an exit will be deliberately
        blocked so that the staff and employees will be familiar with alternative routes.



D.     FIRE TRAINING/INSPECTION



                                   Fire Evacuation/Fire Drills – Deerfield Center
                                                   Page 2 of 3
                                                                                                 Effective 03/10




  1. Annually, and as changes occur, staff will be trained on fire evacuation and drill procedures.

  2. Designated staff (Administrative Assistants and Program Instructors for adult services) will be
     trained by the local fire chief/designee on proper fire suppression techniques.

  3. Annually, the SSA Director shall request the local Fire Department to inspect the Deerfield Center
     for compliance with local fire codes.


APPROVED:


                                                                                March 26, 2010
       Megan K. Manuel, Superintendent                                              Date




                               Fire Evacuation/Fire Drills – Deerfield Center
                                               Page 3 of 3
                                                                                                   Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

TORNADO EMERGENCY – DEERFIELD CENTER                                                          SECTION 2.42


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a tornado.

PROCEDURE:

A.     TORNADO WATCH

       1.      Occupants will be alerted by a weather radio located in the Division Secretary’s offices.
               An announcement will be made that a tornado watch is in effect.

       2.      Announcements on the weather radio will be monitored by the SSA Division Secretary in
               the front building and the Adult Services Division Secretary for the back building

       3.      Non-ambulatory individuals should get into their wheelchairs to be
               prepared for possible evacuation.

       4.      Individuals should continue programming and staff will review tornado
               plans with groups in anticipation of movement to designated areas.


B.     TORNADO WARNING

       1.      Upon notification of a tornado warning from the weather radio,
               the Director/designee will activate a long continuous
               warning signal with an air horn. An announcement will also be made notifying
               staff/individuals of the tornado warning.

       2.      All individuals will report to the shelter area designated on the map posted in each room.

       3.      The Administrative Secretary of each Division will collect all sign-in sheets
               and attendance rosters and take them to the Division Directors/designees.

       4.      Upon arrival to their designated areas, all individuals will assume shelter-
               body position as follows:

                       a. Sit on the floor facing interior wall
                       b. Head between knees
                       c. Place coat/blanket over head
                       d. Persons in wheelchairs will remain in their chairs

       5.     The Division Directors/designees will check to ensure that everyone is in their assigned
              areas and accounted for.

       6.      Injuries should be reported to the Nurses or Division Director/designee.

       7.      Everyone should remain in their designated areas until an all clear is
               sounded/announced by their Division Director/designee.



                                  Tornado Emergency – Deerfield Center
                                             Page 1 of 2
                                                                                               Effective 03/10




C.   DRILLS

     1. The SSA Director/designee and the Adult Services Director/designee will implement a
          tornado drill once a month during tornado season (April - August) or more frequently as
          determined by the Facility Director/designee.

     2. The Directors/designees will instruct the Secretary or other designated staff person to
        proceed with the following:

             a.   Get stopwatch and air horn or whistle.
             b.   Announce the drill and blow horn.
             c.   Start the stopwatch to time the drill.
             d.   Monitor drill by making sure everyone is in the appropriate tornado shelters.
             e.   Once everyone is in, make sure there is at least one Disaster Kit in each area.
             f.   Stop the watch for time.
             g.   Announce “all clear.”

     3.      The Directors/designees will write Emergency Drill Documentation sheet and submit a
             copy to the Safety Chairperson, Administrative Secretary, Administration Office. The
             original sheet should be kept in respective division Secretary’s office(s).

     4.      Any issues/concerns that arise as a result of the drill will be discussed with staff at the
             next staff meeting.



APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                                Tornado Emergency – Deerfield Center
                                           Page 2 of 2
                                                                                                  Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

POWER FAILURE – DEERFIELD CENTER                                                       SECTION 2.43


PURPOSE: To ensure safety of enrolled individuals/staff of Deerfield Center in the event of a power
failure.

PROCEDURE:

A.   POWER FAILURE

     1. The facility will remain status quo until the power company either remedies the situation, or the
        Division Directors/designees deem it to be in the best interest of their Division to close the
        facility for their division.

     2. If the facility is to be closed, the Division Directors/designees will notify the Superintendent and
        the Transportation Division if necessary to have enrolled individuals transported home.

B.   LIGHTING

     1. Emergency back up lighting is located throughout the building.

     2. Front Building: Battery powered emergency lighting will be tested once a month by the facility
        maintenance representative and once quarterly during the internal inspection.

     3. Rear Building: Emergency generator will be tested monthly.

C.   FIRE ALARM/ INTRUSION ALARM SYSTEMS

     1. The fire alarm and intrusion alarm systems also has a battery operated back up power source
        in the event of a power failure.

           a. The Alarm Company representatives will test the emergency back up yearly.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                      Power Failure – Deerfield Center
                                                Page 1 of 1
                                                                                                 Effective 03/10




                     WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                    AGENCY PROCEDURE

BOMB THREAT – DEERFIELD CENTER                                                             SECTION 2.44


PURPOSE: To ensure the safety of all enrolled individuals/staff in the event of a bomb threat.

PROCEDURE:

A.      UNUSUAL ACTIVITY

        1. Staff should report any unusual circumstances, persons, or objects in the building or
           surrounding area, to their Director/designee.

        2. If deemed necessary, their Director/designee should evacuate the facility. See “C. Notifying
            Director.”

B.      WHEN BOMB THREAT IS RECEIVED

        1. Keep caller on the line as long as possible
        2. Do not hang up or disconnect the line
        3. Direct other personnel to call the operator and request an emergency trace stating, “We
           have a BOMB THREAT.”
        4. Other personnel (secretary, Director, etc…) should contact Warren County
           Telecommunications (ext. 1320) and tell them that there has been a bomb threat. Report,
           which line the caller, is on and ask that the line be traced.
        5. Attempt to gain the following information:
                a. location of the bomb
                b. time of detonation
                c.    name of caller
                d. identifying characteristics of caller’s voice

C.      NOTIFYING DIRECTOR

        1. The Director/designee will activate the fire alarm and evacuate the building immediately.

        2. The Director should immediately inform the Lebanon Police/Fire
           Department of the bomb threat. (call/dial 911)

        3. Once the safety of all persons is ensured, the Superintendent will then be notified. If the
           building cannot be re-entered the Superintendent or designee will notify the transportation
           division and arrange to have enrolled individuals transported home or to the emergency
           evacuation site (PSU).
        4. Staff will remain until all enrolled individuals have been picked up.

        5.   No person will be permitted to enter the building until it has been declared safe by the
             Superintendent or Director/designee.


                                        Bomb Threat – Deerfield Center
                                                Page 1 of 2
                                                                                             Effective 03/10




     6. If evacuation occurs during inclement weather, staff should assist enrolled individuals to the
         emergency evacuation site, Production Services Unlimited.


APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                                   Bomb Threat – Deerfield Center
                                           Page 2 of 2
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EARTHQUAKE EMERGENCY – DEERFIELD CENTER – Front and/or Rear Buildings SECTION 2.45


PURPOSE: To ensure the safety of all enrolled individuals and staff at the Deerfield Center in the event
of an earthquake.

PROCEDURE:

A.     IF INDOORS DURING AN EARTHQUAKE

           1.      When you feel an earthquake, all individuals should be relocated to a tornado shelter,
                   individuals using wheelchairs should be positioned as close as possible to supporting
                   walls. All other persons should move or stay away from windows, file cabinets,
                   bookcases, heavy mirrors, hanging objects, or ceiling tiles. Stay under cover until the
                   shaking stops.

           2.      When it is believed safe, the Ranking Administrator or designee will initiate
                   evacuation of the area by using the FIRE EVACUATION PROCEDURE.

           3.      Maintenance staff or designee will secure and shut off the utilities to the building,
                   following emergency shut off procedure.

B.     IF OUTDOORS DURING AN EARTHQUAKE

           1.      Do not enter the building. Proceed to the closest FIRE EVACUATION waiting area.

           2.      Move away from all structures, utility poles, downed power lines, trees and signs.

            3.      If you are driving pull over to the side of the road and stop. Avoid overpasses, power
                    lines and other hazards. Stay inside the vehicle until the shaking stops.

C.      AFTER THE EARTHQUAKE STOPS

            1.     The Senior Administrative staff on site or designee will assure that all participants
                   and employees are accounted for. A list of any missing persons and their possible
                   whereabouts will be compiled.

           2.      The Senior Administrative staff designee will coordinate the assessment of any
                   injuries and will be assisted by the first aid team. A nurse or designee will report to
                   the Senior Administrative staff on site or designee, who will arrange to call the
                   EMERGENCY SQUAD if anything other than routine FIRST AID is required.

           3.      The Senior Administrative staff on site or designee will report any missing persons to
                   the Lebanon Fire Department.

           4.      If the facility is to be closed, transportation will be notified and individuals will be
                   evacuated to their homes or the emergency evacuation site (PSU)




                                 Earthquake Emergency – Deerfield Center
                                              Page 1 of 2
                                                                                      Effective 03/10




APPROVED:


                                                                     March 26, 2010
      Megan K. Manuel, Superintendent                                    Date




                           Earthquake Emergency – Deerfield Center
                                        Page 2 of 2
                                                                                                 Effective 03/10




                      WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                     AGENCY PROCEDURE

TOXIC SPILL – DEERFIELD CENTER                                                            SECTION 2.46


PURPOSE: To ensure the safety of enrolled individuals and staff at the Deerfield Center in the event of a
toxic spill.

PROCEDURE:

A.    HAZARDOUS MATERIAL SPILLS INCL UDE THE RELEASE OF SUDDEN DISCHARGE IN
      HARMFUL OR REPORTABLE QUANTITIES OF:

      1.   Oil or other petroleum products

      2.   Hazardous waste that may be hazardous or detrimental to:

                 a. Surface or ground water
                 b. Air quality
                 c. Surrounding land and fixtures (trees, shrubs, etc.)

      3.    Hazardous materials include:

                 a.    Explosives
                 b.    Flammable liquids
                 c.    Water reactive substances
                 d.    Oxidizing materials
                 e.    Poisonous or toxic materials
                 f.    Radioactive materials
                 g.    Corrosive materials

      4. A material is considered hazardous material if:

                 a. Specifically listed in the law, 29 CFR parts 1910 subpart Z, Toxic and Hazardous
                    Substances (Z List).
                 b. Assigned a threshold limit value (TLV) by the American Conference of Governmental
                    Industrial Hygienist, Inc. (ACGIH).
                 c. Determined to be cancer causing, corrosive, toxic, an irritant, a sensitizer, or has a
                    damaging effect of specific body organs.

B.    ALL SPILLS OR POTENTIAL SPILLS MUST BE REPORTED IMMEDIATELY, INCLUDING THE
      FOLLOWING:

            1.   Chemical spills
            2.   Accidents involving chemicals with potential spills
            3.   Fires with chemicals involved
            4.   Fuel tank delivery overfills
            5.   Oil spills where product enters a watercourse

C.    ENCOUNTERING A SPILL AND WHAT TO DO:

            1. All spills must be reported to the Division Director or designee.
            2. Without endangering yourself or others, try to stop the flow of hazardous materials and
               prevent the spill from spreading.


                                          Toxic Spill – Deerfield Center
                                                  Page 1 of 2
                                                                                                 Effective 03/10




         3. ONLY TRAINED PERSONNEL WILL BE PERMITTED IN T HE AREA TO CLEAN UP
            THE SPILL!
         4. The law requires the person having the spill to report the spill. If you know about it, you
            MUST REPORT IT IMMEDIATELY!

D.   WHEN REPORTING A SPILL GIVE THE FOLLOWING INFORMATION:

         1.   Name of person reporting the spill
         2.   Location of spill
         3.   Material involved
         4.   Estimated volume
         5.   Whether source is controlled
         6.   Whether a water source is involved

E.   INTERNAL TOXIC SPILL (SPILL OCCURRING INSIDE FACILITY), THE SENIOR DIRECTOR ON
     SITE OR DESIGNEE WILL INITIATE THE FOLLOWING:

         1. Evacuate all individuals from the facility utilizing the fire evacuation procedure.
         2. Immediately notify the Local Fire Department and the Senior Director on site or designee
            who will call 911 and ask to have the Haz Mat coordinator
            dispatched to the site (932-4080).
         3. Provide all the information to each as identified in Spill Report Information as listed in this
            procedure.
         4. FOLLOW SAFETY OFFICIALS RECOMMENDATIONS.
         5. If the facility is to be closed, the Superintendent or designee will notify the transportation
            division and arrange to have participants transported home.
         6. No individual may reenter the facility until the local authorities give the “all clear”.

F.    EXTERNAL TOXIC SPILLS (SPILLS OCCURRI NG OUTSIDE A FACILITY), THE SENIOR
      DIRECTOR ON SITE OR DESIGNEE WILL INITIATE THE FOLLOWING:

         1. Immediately notify the Local Fire Department, Environmental Protection Agency and
            provide all the information to each as identified in SPILL REPORT FORM as listed in this
            procedure.
         2. The senior director on site or designee will notify the Superintendent or designee of the
            situation.
         3. If the facility is to be closed, the Superintendent or designee will notify the transportation
            division and arrange to have participants transported home or to the emergency
            evacuation site (PSU).



APPROVED:


                                                                                March 26, 2010
       Megan K. Manuel, Superintendent                                              Date




                                     Toxic Spill – Deerfield Center
                                             Page 2 of 2
                                                                                                   Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EMERGENCY SHUTOFF – DEERFIELD CENTER                                                        SECTION 2.47


PURPOSE: To ensure the safety of all enrolled individuals and staff of the Deerfield Center in the event
of an emergency requiring shut off of the utilities.

PROCEDURE:

FRONT BUILDING

    A.      IF SHUTTING OFF THE UTILITIES TO THE BUILDING BECOMES NECESSARY DUE TO
            EMERGENCY CIRCUMSTANCES DO THE FOLLOWING:

            1. If possible call the Operations Director at 513-518-1848.

            2. Locate the main water shut-off to the left of electric panels in the center hall mechanical
               room. Turn ¼ turn to off position.

            3. Locate 2 electrical panels on left hand wall and switch to off position.

REAR BUILDING

    A.      IF SHUTTING OFF THE UTILITIES TO THE BUILDING BECOME NECESSARY DUE TO
            EMERGENCY CIRCUMSTANCES DO THE FOLLOWING:

            1. If possible, notify the Operations Director at 513-518-1848.

            2. Locate the water main shutoff inside the northeast mechanical room. Turn the water
               valve counter clockwise until it will no longer turn

            3. Locate the electrical panels in the south mechanical room and switch off the main box
               (long handle in center box) on the outside wall.



APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                    Emergency Shutoff – Deerfield Center
                                               Page 1 of 1
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

VIOLENT OR THREATENING SITUATION – Deerfield Center                                        SECTION 2.48


PURPOSE: To ensure the safety of enrolled individuals and staff of Warren County Board of DD in the
event of a violent or threatening situation

PROCEDURE:

A.     Immediately upon recognition of a violent or threatening situation on or near DD property such as,
       but not limited to:

       1.      Any person in possession of a deadly weapon.

       2.      Any person observed in violent or threatening actions or behaviors.

       3.      Any person displaying behavior that would indicate they were under the influence of
               drugs or alcohol.

       4.      Any series of circumstances or behavior(s) that could reasonably be determined to pose
               an immediate threat to the health and/ or safety of enrolled individual(s) and/or staff of
               WCBDD.

B.     The person observing such activity will not intervene unless they are trained to do so, however
       they should try to remove any enrolled individuals from immediate danger if possible.

C.     Any staff in the immediate vicinity should be notified to aid in moving enrolled individuals to safe
       location(s) and the senior Director or Supervisor should be notified immediately.

D.     The Director/designee of the other building at the site shall notify the appropriate authorities and
       the Superintendent/designee. The administrative assistant/designee shall contact staff as quickly
       as possible.


       1.      Upon notification: Staff should lock themselves and any enrolled individuals that may be
               with or near them in their classroom, office unit with the lights off and await further
               instructions. . While remaining in their location, they should avoid windows and doors.

       2.      If notified to evacuate: all staff should proceed to evacuate the building quickly and
               quietly, following the fire evacuation procedure, making sure that any enrolled individuals
               in their area are aided and accounted for. They should await further instructions at the
               designated evacuation sites.

E.     If evacuation from the site is required, at the direction of the Superintendent/designee or
       Emergency personnel, DD Transportation shall be notified to transport enrolled individuals as
       needed. Evacuation to alternate sites would be:

F.     Returning to regular activities:

       1. The administrative assistant/designee shall notify staff by phone or in person, that “it is ok to
          return to regular activities”.




                              Violent or Threatening Situation – Deerfield Center
                                                  Page 1 of 2
                                                                                                      Effective 03/10




This means that staff and enrolled individuals can return to normal activities (a code is utilized to minimize
the chances of someone being forced to announce an “all clear” and provide access for an intruder).


APPROVED:


                                                                                     March 26, 2010
          Megan K. Manuel, Superintendent                                                Date




                               Violent or Threatening Situation – Deerfield Center
                                                   Page 2 of 2
                                                                                               Effective 03/10




                   WARREN COUNTY BOARD DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

QUARTERLY INTERNAL INSPECTION                                                          SECTION 2.49



Purpose:

To maintain a healthy and safe environment for individuals served, staff, and all people that enter DD
facilities.

Procedure:

A member of the DD staff shall inspect each facility every 3 months using the Quarterly Inspection form
(AGF-068) as a guideline. The original shall be forwarded to the Operations Director who shall then
review the results of the inspection. The Operations Director shall make sure that any item(s) that
requires correction is addressed and the results documented.



APPROVED:


                                                                              March 26, 2010
         Megan K. Manuel, Superintendent                                          Date




                                       Quarterly Internal Inspection
                                               Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

THIRD PARTY INSURANCE                                                                       SECTION 3.00


PURPOSE:         Fees from third party payers for services provided by the Board.

PROCEDURE:

A. Except as stated in these procedures, the Board will make reasonable efforts to identify third party
   payers who may be available to provide payment for services provided to individuals by the Board
   and to collect payment from such third party payers in accordance with the rate structure defined in
   Attachment 1.

B. RATE STRUCTURE

The Rate Structure attached, as Attachment 1 shall be used for billing third party payers, which provide
coverage to individuals or families receiving services from the Board.

C. DETERMINATION OF AVAILABLE THIRD PARTY PAYERS

    1. Determinations of Third Party Payers, which may be available for coverage of services provided
       by the Board, shall be made at the time of initial enrollment and repeated at least once per year
       thereafter at the time of the ISP team meeting.

    2. All individuals or their families shall be instructed to notify the Board of any change in such third
       party payers.

D. REASONABLE EFFORTS TO SEEK REIMBURSEMENT

The Board will be deemed to have made reasonable efforts to seek reimbursement if the Board submits
claims to third party payers identified as available to the individual in accordance with procedures adopted
by such payers. If the claim is denied, an appeal is not required if the Board determines that there is no
reasonable likelihood of success if an appeal were filed.

E. RULES BY ODODD

These procedures are subject to rules promulgated by ODODD pursuant to O.R.C. § 5126.045. In the
event that ODODD adopts rules under O.R.C. § 5126.045 and any part of this policy is inconsistent with
such rules, the provisions of such rules shall apply.




                                            Third Party Insurance
                                                 Page 1 of 2
                                                                                     Effective 03/10




Attachment One: Rate Structure



                                                              Family Co-Pay %

$27,258 or LESS      ______________                                0%

$27,259 to $37,759   ______________                               10%

$37,760 to $48,260   ______________                               30%

$48,261 to $62,261   ______________                               50%

$62,262 to $79,762   ______________                               75%

OVER $79,763         ______________                              100%




APPROVED:


                                                                    March 26, 2010
        Megan K. Manuel, Superintendent                                 Date




                                      Third Party Insurance
                                           Page 2 of 2
                                                                                                    Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

AGENCY ELIGIBILITY                                                                           SECTION 3.01


PURPOSE:            To clearly define the eligibility process and procedures to be followed when determining
eligibility for individuals requesting services from the Warren County Board of DD.

PROCEDURE:

A.      REQUEST FOR SERVICES:

        1. All initial requests for services provided by the Warren County Board of Mental Retardation
           and Developmental Disabilities (WCBDD) will be initiated through the Service and Support
           Administration Division. These services include Adult Services, Family Services, Residential
           Services, and Service Coordination Services. Eligibility for services must be determined prior
           to service delivery.

        2. The Intake Specialist will complete a Referral Data Sheet when taking the initial request for
           services and will explain the eligibility requirements and agency services available. The
           Intake Specialist will request verification of developmental disability information. The Intake
           Specialist will log the date the referral was received in the referral log. The Intake Specialist
           will set up a file for the individual requesting services. The Intake Specialist will also check
           closed and ineligible files to ensure eligibility has not already been determined. The Intake
           Specialist will document initial contact with individual/family/guardian. If unable to contact
           individual/family/guardian, a second attempt will be made within one (1) week. If after three
           (3) weeks of no contact, a letter will be sent by certified mail to the individual/family/guardian
           requesting that a meeting be scheduled. If no contact is made within ten (10) days of receipt
           of the certified letter, the Intake Specialist will place the file in inactive status.

        3. When verification of developmental disability information is received from the referral source,
           the Intake Specialist will log the date of receipt in the referral log. The Intake Specialist will
           then schedule an appointment to complete the Children’s Ohio Eligibility Determination
           Instrument (COEDI) or the Ohio Eligibility Determination Instrument (OEDI), as applicable.
           The Intake Specialist will complete eligibility determination within forty-five (45) days from the
           date that verification of developmental disability is received.

        4. Upon completion of the COEDI or OEDI, the Form for Eligibility Determination (FED) and the
           file will be forwarded to the Service and Support Administration Assistant Director for review
           and signature. The Intake Specialist will also complete an Individual Information Form (IIF)
           for eligible individuals, to be submitted to the WCBDD Fiscal Specialist.

        5. Upon completion of eligibility determination, individuals applying for services are notified in
           writing the results of this determination. If eligible, the person will be referred to the programs
           or services requested and the person will be enrolled for services or will be placed on a
           waiting list for the program or service. If the person is determined ineligible, they will be
           provided information regarding other services, which may be of benefit and will be given
           information on the Administrative Resolution of Complaints procedure.

B.      ELIGIBILITY CRITERIA:

        1. To be eligible to receive WCBDD services one must live in Warren county and meet eligibility
           criteria for their age group or must be “grandfathered” for DD services. (“Grandfathering”
           refers to individuals who were determined eligible for DD services and were receiving


                                               Agency Eligibility
                                                 Page 1 of 3
                                                                                              Effective 03/10




    services on July 1, 1991. For children who were “grandfathered” on July 1, 1991, that child is
    eligible until adult eligibility determination is required. For adults who were “grandfathered”
    on July 1, 1991, they are “grandfathered” indefinitely.)

2. Service Coordination services are available to most eligible individuals over the age of three
   (3) through the Service and Support Administration Division.

3. All individuals enrolled on Home and Community Based Waivers and in Supported Living will
   be assigned a Service Coordinator.

4. All individuals receiving WCBDD Adult Services will be assigned a Service Coordinator,
   unless they reside in an Intermediate Care Facility for the Mentally Retarded (ICF/MR). If
   individuals reside in an ICF/MR the QMRP from the ICF/MR and the WCBDD Program
   Instructor will coordinate the Adult Services ISP.

5. Individuals residing in ICF/MR Facilities will only be assigned a Service Coordinator if they
   require coordination of moving out of an ICF/MR facility and into a community setting.

6. For children ages three to six, two developmental delays must be present to receive services.
   This is determined by the individual’s school district of residence or by referral information
   presented to WCBDD. (Based on Ohio Department of Health Established Risks and ODODD
   standards for eligibility.)

7. For children age six to sixteen, a diagnosis of a developmental disability must be made prior
   to referral for DD services. After documentation of this developmental disability is received,
   the Intake Specialist will complete the Children’s Ohio Eligibility Determination Instrument
   (COEDI). If the results of this instrument indicate that the child has at least three areas of
   substantial functional limitation in the areas of self-care, receptive and expressive language,
   learning, mobility, self-direction, and/or capacity for independent living, then the child is
   eligible for DD services. (Based on ODODD eligibility standards.)

8. For individual’s age 16 and older, a diagnosis of a developmental disability must be
   documented prior to referral for DD services. After documentation of this developmental
   disability is received, the Intake Specialist will complete the Ohio Eligibility Determination
   Instrument (OEDI). If results of this instrument indicate that the individual has at least three
   areas of substantial functional limitation in the areas of self-care, receptive and expressive
   language, learning, mobility, self-direction, capacity for independent living, and/or capacity for
   economic self-sufficiency, then the individual is eligible for DD services. (Based on ODODD
   standards.)

9. A “Developmental Disability” means a severe, chronic disability that is characterized by all of
   the following:

a. Disability is attributable to a mental or physical impairment or combination of mental and
   physical impairments, other than a mental or physical impairment solely caused by mental
   illness as defined in division (A) of Section 5122.01 of the Ohio Revised Code;
   b. Disability is manifested before the age of twenty two;
   c. Disability is likely to continue indefinitely.
   d. It results in one of the following:

        i.   In the case of a person under age three, at least one developmental delay or an
             established risk;
        ii. In the case of a person at least age three but under six, at least two developmental
             delays or an established risk;
        iii. In the case of a person age six or older, a substantial functional limitation in at least
             three of the following areas of major life activity, as appropriate for his age: self-care,

                                       Agency Eligibility
                                         Page 2 of 3
                                                                                                  Effective 03/10




                 receptive and expressive language, learning, mobility, self-direction, capacity for
                 independent living, and, if the person is at least age sixteen, capacity for economic
                 self-sufficiency.

         e. It causes the person to need a combination and sequence of special, interdisciplinary, or
            other type of care, treatment, or provision of services for an extended period of time that
            is individually planned and coordinated for the person.

     10. A “Developmental Delay” means that a child has not reached developmental milestones
         expected for his chronological age as measured by qualified professionals using appropriate
         diagnostic instruments and/or procedures.

         a.   Delay shall be demonstrated in one or more of the following
              developmental areas: adaptive behavior; physical developmental or
              maturation (fine and gross motor skills; growth); cognition;
              communication; social or emotional development; and sensory
              development;

         b.    An established risk involving early aberrant development related to diagnosed
              medical disorders, such as infants and toddlers who are on a ventilator, are adversely
              affected by drug exposure, or have a diagnosed medical disorder or physical or mental
              condition known to result in developmental delay such as Downs syndrome.

C.   EARLY INTERVENTION SERVICES:

     1. When the Intake Specialist is the first contact for a referral of child from birth to age three, the
        Intake Specialist will refer the family to Help Me Grow. A Help Me Grow Service Coordinator
        will do a visit to the child’s home to conduct the initial intake and will complete a
        developmental screening. If the child is eligible for DD services, the Help Me Grow Service
        Coordinator will contact the Early Intervention Supervisor. If the family would like Family
        Support Services, the Help Me Grow Service Coordinator will contact the WCBDD Family
        Support Coordinator. The Intake Specialist is dependent on the above process for
        verification of risk factors and/or delays. (It is possible for a child to be eligible for Early
        Intervention Services but for this child not to be eligible for other DD services if the child’s
        only identified risk in environmental.)



APPROVED:


                                                                                 March 26, 2010
      Megan K. Manuel, Superintendent                                                Date




                                            Agency Eligibility
                                              Page 3 of 3
                                                                                                    Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EXIT FROM AGENCY                                                                             SECTION 3.02


PURPOSE:         To clearly define the withdrawal/exit procedure to be followed when and individual no
longer is in need of services from the Warren County Board of DD.

PROCEDURE:

A. If an individual receiving services from Warren County Board of DD withdraws from the agency, the
   Division Designee will complete a “Withdrawal/Exit Report”, revise the IIF, complete the Database
   Change Form, and route these items to the appropriate Division Directors to review. The Division
   Directors will review and send to the Service and Support Administration Secretary to make
   appropriate copies for files, change client database, and send original IIF to the Fiscal Specialist.

B. The Fiscal Specialist will revise the IIF in the Infallible System and then send a copy of the revised IIF
   to ODODD.

C. The appropriate Division Director/Designee will ensure that:

    1. If an individual exits program due to death, the Division Director/Designee reviewing this form will
       ensure that a Major Unusual Incident report is done, if not already completed.
    2. If an individual exits the program for other reasons, the Division Director/Designee will assign a
       Division Designee to complete a follow up call to this individual or family, if applicable.

D. The Division Designee assigned to do follow up on this case will contact the individual or family and
   complete the “Client Status/Follow-Up Report”.

    1. If there is an individual or a family who does not have a Division Designee, the Division
       Director/Designee will ensure that a “Client Status/Follow Up Report” is completed.
    2. If additional service needs are identified during the follow up call, the Division Designee will
       secure information regarding resources to        meet this need. The Division Designee will assist
       the individual and/or family in making any further referrals for this service or will provide
       information regarding this service to the individual and/or family.

E. Completed “Client Status/Follow Up Report” will be maintained in the individual’s main file.

F. Copies of “Client Status/Follow Up Report” will be sent to WCBDD Division Directors providing
   services to the individual and to the Superintendent of WCBDD.

G. Annually, the Division Director will review “Client Status/Follow Up” Reports (June of each year).
   For those individuals indicating they would like further follow-up, the Division Director will assign a
   Division Designee to make a follow up call.

APPROVED:


                                                                                   March 26, 2010
          Megan K. Manuel, Superintendent                                              Date




                                              Exit from Agency
                                                Page 1 of 1
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

DEATH OF AN ENROLLED INDIVIDUAL                                                            SECTION 3.03



PURPOSE:

To establish a systematic means of identifying each Warren County Board of DD employee responsible
for obtaining and/or informing other entities regarding the death of an individual receiving services from
the agency.

PROCEDURE:

    A.      Individuals whose residence was with entities under the jurisdiction of Ohio Department of
            Health (Nursing Homes, ICFMR’s not licensed by ODODD):

            DOCUMENTATION                               STAFF RESPONSIBLE
             1. Copy of death certificate               Investigative Agent
             2. Location of death (i.e. Hospital, home)                 I/A
             3. Whether the death was expected or                       I/A
                 unexpected.
             4. Provide reason death was reported to                    I/A
                 ODODD. (What services were being
                 provided?)

    B.      Cases involved children and adults who live at home and who had access to health care and
            died in a hospital. (Access to health care is defined as having access to a primary care
            physician or advanced practice nurse on some recurring basis-at least annually.) Note that
            there is a statutory requirement (ORC 307.621) for all children less than 18 years of age to be
            reviewed by local counties.

            DOCUMENTATION                                  STAFF RESPONSIBLE
             1. Copy of death certificate                             I/A
             2. Location of death (i.e. emergency room,
                 Hospital inpatient, home, nursing home).             I/A
             3. Whether the death was expected or unexpected I/A
             3. Enter a narrative on the Incident Tracking
                 System (ITS) regarding the circumstances
                 Surrounding the death whenever possible.
                 This would include whatever occurred
                 during the 72 hours prior to the hospitalization
                 (i.e. events, activities).

    C.      Person who died of cancer or were in a hospice program at the time of death:

            DOCUMENTATION                              STAFF RESPONSIBLE
            1. Copy of death certificate                          I/A
            2. Location of death (i.e. emergency,                 I/A
               hospital inpatient, home, nursing
               Home).
            3. Indicate if Do Not Resuscitate (DNR) order in      I/A
               effect; type of DNR order (DNR Comfort Care,
               DNR Comfort Care-Arrest, other), reason for
               DNR order, and involvement of individual/guardian

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        in obtaining the DNR order.
     4. Enter into the ITS pertinent past medical treatment     I/A
        indicating health care screening that was conducted
        and dates and results of health care screenings (cancer
        screenings).

D.   All other deaths not covered in the above categories:

     DOCUMENTATION                                   STAFF RESPONSIBLE
     1. Copy of death certificate                                    I/A
     2. Copy of autopsy (if done)                                    I/A
     3. A copy of the Corner’s verdict page or ruling in
         cases where the Corner ruled on the cause of death
         but no autopsy was done.
     4. Outcome of law enforcement investigation
         (when they are involved).
     5. Location of death (i.e. emergency room, hospital
         Inpatient, home, nursing home).
     6. Whether the death was expected or unexpected
     7. Enter on ITS the medical diagnoses prior to death
     8. Enter on ITS the psychiatric diagnoses prior to death.
     9. Enter in ITS pertinent past medical history (i.e., surgeries,
         Recent treatments, illness, and chronic medical problems).
     10. Enter on ITS a narrative on the circumstances surrounding
     11. the death. This would include whatever occurred during the 72 hours prior to the
         hospitalization (i.e., events, activities).
     12. Indicate if DNR order in effect, type of DNR order (DNR Comfort Care, DNR Comfort
         Care-Arrest, other), reason for DNR order, and involvement of individual/guardian in
         obtaining the DNR order.
     13. Enter on ITS a list of services that the person received if unable to answer or provide
         information relative to number 5 through 13.

E.   When a person dies, specific actions need to occur to remove their name from the system
     and prevent possible fraud and/or theft. These responsibilities include:

     1. For Individual Options and Level I Waivers the Medicaid Manager is responsible to
        submit a revised PAWS to stop billings.
     2. The Medicaid Manager shall notify the Warren County Department of Job and Family
        Services in order to enter the information into CRIS-E and stop the billing payment
        process.
     3. The Service Coordinator shall notify the Warren County Probate Court.
     4. The Service Coordinator shall notify the Social Security Administration.
     5. The Service Coordinator should assist, whenever possible, to ensure bank accounts
        become part of the estate.
     6. Follow the Agency Withdrawal/Exit From Agency Procedure.




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All deaths of persons with DD are to be reported to the Warren County Coroner by the attending
physician, EMS staff, and involved law enforcement officers.




APPROVED:


                                                                              March 26, 2010
         Megan K. Manuel, Superintendent                                          Date




                                      Death of an Enrolled Individual
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                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

OUTCOMES MEASUREMENT SYSTEM                                                               SECTION 3.04


PURPOSE:
To establish a systematic means of outcomes measurement for all within the agency.

PROCEDURE:

A.     For all outcomes systems, the following quarters have been established:

               QUARTER 1                January, February, March
               QUARTER 2                April, May, June
               QUARTER 3                July, August, September
               QUARTER 4                October, November, December
               ANNUAL                   January – December

B.     Following procedures established by each division, quarterly information should be gathered by the
       Director of the program area. Each Director will prepare a quarterly report and submit it to the
       Director of Quality Assurance no later than the tenth day past the end of the quarter. Each
       quarterly report will be combined and presented to the Superintendent.

C.     If an objective is measured on an annual basis only, it will not be reflected in the quarterly report.
       Total data for the year will be summarized in the annual report.

D.     Quarterly reports will be presented to Division Directors at monthly management meetings.
       Outcomes results should be discussed in that forum and alternate strategies to programs/service
       delivery should be formulated if necessary.

E.     Quarterly reports will be presented to the Board by the Superintendent at the end of the month that
       follows each quarter. At the end of each calendar year, aggregate information should be
       calculated.

F.     Using average data from the quarterly reports, each Director of the program area will develop an
       annual outcomes report which will include:

       1.      Aggregate Data on Efficiency, Effectiveness, and Satisfaction measures

       2.      Readjustment of Outcomes Objectives/Goals

       3.      Narrative Summaries

       4.      Demographics

       5.      Annual Vision Statement

G.     Using information from the annual report, each Division Director should adjust the outcomes
       measurement system for the upcoming year, if necessary.

H.     All outcomes information will be used to guide:

       1. Agency Annual Plan and other strategic planning



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     2. Individual Plans (IP, ISP, IFSP)




APPROVED:


                                                                March 26, 2010
      Megan K. Manuel, Superintendent                               Date




                                  Outcomes Measurement System
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               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

BEHAVIOR SUPPORT                                                                        SECTION 3.05



     Administrative Rule 5123:2-1-02 applies to all programs and services provided by a county board
     of DD. These guidelines shall promote growth, development, and independence as well as
     individual choice in daily decision-making and self-management. When services are contracted, it
     is the responsibility of the county board to assure that the services being provided are in
     accordance with the rules of the Department. These guidelines were prepared with input from
     representatives from many organizations, agencies, and families.

PROCEDURE:

A.   WHO THESE GUIDELINES APPLY TO:

     As used in this procedure, “provider” refers to all persons and entities that provide specialized
     services, as defined in Section 5126.281 of the Revised Code, and that are subject to regulation
     by the department, regardless of the source of payment, including:

     1.      A contracting entity of a county board, as defined in Section 5126.281 of the Revised
             Code. This includes all Warren County programs with WCBDD employees (i.e, Day
             Program).

     2.      A provider licensed under section 5123.19 of the Revised Code. For the purposes of this
             policy, “Provider” does not mean an Intermediate Care Facility for the Mentally Retarded
             (ICF/MR) certified under Title XIX of the Social Security Act. Though the ICF/MRs are not
             considered providers under this policy, it is the intent of the county board to put forth a
             collaborative effort to create and provide appropriate positive behavioral supports.

     3.      A provider of Supported Living under Section 5126.431 of the Revised Code.

     4.      A provider of Respite Care certified under Sections 5123.171 and 5126.05 of the Revised
             Code.

     5.      A provider approved to provide Medicaid services under home and community-based
             service waivers (IO, Level 1, Martin) administered by the department.

B.   INDIVIDUAL CHOICES:

     1.      Individual Choices in decision-making, emphasizing self-determination and self- support,
             to the extent possible.

     2.      The person should be encouraged to express their wishes, dreams, plans, and goals.
             The individual’s choices shall be the primary factor for developing the Behavior Support
             Plan. The Behavior Support Plan should address all areas of the individual’s life and
             should coordinate these services to meet the needs of the individual served. The
             Behavior Support Plan should identify concrete activities and measurable objectives that
             the service providers can perform to assist the person in achieving his/her wishes, plan
             and goals.



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C.   PROHIBITED ACTIONS:

     1.    Prohibited actions are reported as major unusual incidents in accordance with rule
           5123:2-17-02 of the Administrative Code. Prohibited actions shall include the following:

           a.     Any physical abuse of an individual such as striking, spitting on, scratching,
                  shoving, paddling, spanking, pinching, corporal punishment or any action to inflict
                  pain.
           b.     Any sexual abuse of an individual.
           c.     Medically or psychologically contraindicated procedures.
           d.     Any psychological/verbal abuse such as threatening, ridiculing, or using abusive
                  or demeaning language.
           e.     Placing the individual in a room with no light.
           f.     Subjecting the individual to damaging or painful sound.
           g.     Denial of any meal.
           h.     Squirting an individual with any substance as a consequence for a behavior.
           i.     Time-out in a time-out room exceeding one hour for any one incident and
                  exceeding more than two hours in a twenty-four hour period. Use of a time-out
                  room requires the additional oversight specified in this policy and the following
                  safeguards;

                  1.      A time-out room shall not be key locked, but the door may be held shut
                          by a staff person or by a mechanism that requires constant physical
                          pressure from a staff person to keep the mechanism engaged.

                  2.      The room must be adequately lighted and ventilated, and provide a safe
                          environment for the individual.

                  3.      An individual in a time-out room must be protected from hazardous
                          conditions including, but not limited to, presence of sharp corners and
                          objects, uncovered light fixtures, or unprotected electrical outlets.

                  4.      The individual must be under constant visual supervision by staff at all
                          times.

                  5.      A record of time-out activities must be kept.

                   6.     Emergency placement (i.e., without a written plan) of an individual in a
                          time-out room is not allowed.

           j.     Systematic, planned intervention using manual, mechanical, or chemical
                  restraints, except when necessary to protect health, safety, and welfare and only
                  when all other conditions required by this policy are met.

           k.     Medication for behavior control, unless it is prescribed by and under    the
                  supervision of a licensed physician who is involved in the interdisciplinary
                  planning process.

D.   GENERAL INFORMATION:

     1.    All behavior support terms used in the behavior support policy and procedures, shall be
           defined in the Definition Section of this Procedure.


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     2.    Medical factors shall be considered in the development of behavior support plans.

     3.    Prior to using any behavior support strategy, the individual’s planning team must ensure
           that sufficient "person-centered" supports have been available to an individual and his
           family and that changes in his settings have been made which could positively influence
           behavior.

     4.    Prior to the development of any behavior support program, a behavior assessment must
           be completed to be used in the development of a structural behavioral support program.

     5.    Behavior support procedures should be used creatively to offer individuals opportunities
           to express needs, make choices, and control their environment without needing to resort
           to disruptive behaviors. They should be used as part of the person centered planning
           process.

     6.    Behavior support programs must be used only with sufficient safeguards and supervision
           and only when the safety, welfare, due process, and rights of the individual receiving
           services are protected.

     7.    Behavior supports must never be used for punishment, for staff convenience, or as a
           substitute for an active treatment or habilitative program. No standing or as-needed
           programs will be permitted.

     8.    Behavior programs using different types of strategies require different levels of review.
           Three levels of review have been delineated based upon the restrictions imposed by
           different types of strategies. The ISP Team doing person centered planning conducts the
           first level of review in the program. The Behavior Support Committee (BSC) conducts the
           second level of review (This includes, but is not limited to the review of all aversive
           plans). The BSC is primarily comprised of members who are not on the ISP team. The
           Human Rights Committee (HRC) conducts the third level of review. The HRC reviews
           programs to ensure that the individual’s rights are not violated. Usually, the HRC only
           reviews programs using aversive procedures but it can review any program the ISP team
           or BSC wants reviewed or when a rights issue arises.

     9.    Behavior programs must include prevention strategies, behavior supports, and positive
           reinforcing components as part of the plan. Aversive or restrictive strategies should be
           used only when they have been determined to be the least restrictive, least intrusive and
           most effective choices, and when appropriate safeguards are in place to protect the rights
           of those involved. The Warren County Board of DD recognizes that any positive or
           general intervention strategy designed to increase or reduce a behavior can be aversive
           based upon the degree of intrusiveness, frequency, and age-appropriateness. Questions
           as to the aversiveness of an intervention should be referred to the Behavior Specialist,
           the Behavior Support Committee and Human Rights Committee for resolution.

     10.   Positive and less aversive teaching and support strategies are demonstrated to be
           ineffective prior to use of more intrusive procedures.

     11.   Policies and procedures, including administrative resolution of complaints procedures in
           accordance with rule 5123:2-1-12 of the Administrative Code, are available to all staff,
           individuals receiving services from the county board, parents of minor children, legal
           guardians, and providers.

E.   BEHAVIOR SUPPORT PLAN WILL BE ATTA CHED TO THE ISP AND MUST INCLUDE THE
     FOLLOWING:

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     1.      Case history (including medical information),
     2.      Results of a behavior assessment to include a structural/functional assessment.
     3.      Baseline data
     4.      Behaviors to be increased and decreased.
     5.      Procedures to be used; including positive teaching strategies and aversive procedures, if
             applicable. (photos of aversive techniques)
     6.      Persons responsible for implementation,
     7.      Signed physicians orders for psychotropic drugs used as chemical restraints
     8.      Review guidelines, and
     9.      Signature/date blocks, including space for dissenting opinions.

F.   QUALIFICATIONS OF PERSONNEL INVOLVED IN BEHAVIOR SUPPORT PROGRAMS:

     Staff involved in the approval of, writing and implementation of behavior programs shall be
     identified and properly trained for the level of involvement necessary for their designated duties
     and position. It is the responsibility of the Superintendent or his/her designee to ensure that staff
     members are properly designated and appropriately trained.

     1.      Training for all new Service Coordinators, Program Instructors, and other staff that
             request training on the behavior support plan process will be given during agency
             orientation. Each Division Director will be responsible for notifying the Behavior
             Specialist of new staff that requires behavior supports and data collection training.
             Training will be documented.

      2.      The plan author (Behavior Specialist) will in-service appropriate staff members on plan
              implementation.

G.   ISP TEAM: (all ISP Team members are present with consent of the person)

     1.      The ISP Team must include:

             a.      The individual for whom the behavior plan is written, the individual who is legally
                     required to give consent, and/or an advocate(s) if the individual desires.
             b.      Anyone else the person requests.

     2.      Ideally, the ISP Team would also include:

             a.      Persons who implement the program.
             b.      Program author.
             c.      Residential provider.
             d.      Behavior Specialist.
             e.      Psychologist.
             f.      Physician
             g.      Parent

H.   THE BEHAVIOR SUPPORT COMMITTEE:

     Serves as a technical review committee to ensure that each behavior support plan reviewed
     includes all components required by the behavior support rule, as well as appropriate strategies
     and methods consistent with the assessment results and with sound behavioral technology to
     achieve the least restrictive effective plan. In conjunction with reviewing each plan for approval or
     rejection, the committee may offer suggestions to the team to address in the plan before it is
     implemented.

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     1.   The task of the committee is to:

                     a. Review and approve or reject all behavior support plans that
                        incorporate aversive methods including restraint and time-out prior to
                        implementation
                     b. Review all ongoing plans that incorporate aversive methods including
                        time-out and restraint
                     c. Also ensures that the ISP Team submitting the plan for review provides
                        proper forms and documentation.
                     d. Recommendations and actions of the Behavior Support Committee will be
                        recorded and forwarded to the Division Director or his/her designee.
                     e. The Behavior Support Committee may consult on any behavioral issue.
                        Their responsibilities are not limited to aversive programs only.
                     f. The Behavior Support Committee at the ISP team request and/or the
                        committee’s discretion may review non-aversive behavioral concerns.

     2.   The Behavior Support Committee should include at least five (5) members
          knowledgeable in behavior support procedures, including administrators, and persons
          employed by a provider who is responsible for implementing behavior support plans, but
          not those directly involved with the plan being reviewed. The author of the behavior
          support plan (Behavior Specialist) will attend committee meetings to provide information
          and to facilitate incorporation of suggested changes. A quorum is needed to approve an
          aversive plan. A quorum will consist of, at a minimum, the Behavior Support Committee
          Chair/designee and three additional committee members.

I.   THE HUMAN RIGHTS REVIEW COMMITTEE:

     1.   The Human Rights committee reviews and prior approves or rejects all behavior support
          plans using aversive methods, including restraint and time-out, and those which involve
          potential risks to the individual’s rights and protections. The Human Rights committee
          shall ensure that the rights of individuals are protected. The Human Rights Review
          Committee serves as a higher order review Committee to ensure that all human rights
          are respected and protected in the implementation of the behavior support plans and
          interventions. The committee reviews behavior support plans to determine whether the
          individual’s behavior is such that it requires a restriction of rights or the use of aversive
          interventions; whether all potential rights restriction in the plan are identified and
          addressed in the informed consent and other approval documents and whether sufficient
          safeguards and protections are built into the program to protect the person’s rights and
          safety. The HRC will evaluate if the proposed program represents the least restrictive,
          viable treatment alternative for the individual. The committee also reviews plans to verify
          that informed consent has been obtained and to provide a secondary check of the
          program’s compliance with the appropriate rules. This committee is not intended to
          duplicate the technical review of the Behavior Support Review Committee, but can
          ensure the technical aspects were addressed by reviewing the approval documentation
          from the Behavior Support Review Committee.

     2.   The membership of the Human Rights Review Committee shall include:

          a.      At least, one parent of a minor or guardian of an individual eligible to receive
                  services from a county board.
          b.      At least, one staff member from a county board or provider who convenes the
                  committee
          c.      An individual who receives services from a county board


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             d.      Qualified persons who have either experience or training in contemporary
                     practices to support behaviors of individuals with developmental disabilities
             e.      At least, one individual who has no direct involvement in the county board’s
                     programs

                         1. A quorum will consist of, at a minimum, the Human Rights Committee
                            Chair/designee and three additional committee members.
                         2. The Behavior Specialists will both sit on the Human Rights committee.
                            The Behavior Specialists will not approve a plan for which he/she is the
                            author.
                         3. Human Rights Committee meetings are scheduled monthly, (the third
                            Thursday of the month), the day following the Behavior Support
                            Committee meetings. These may be cancelled if there are no plans to
                            review.

J.   AVERSIVE PLAN REVIEW PROCEDURES:

     Aversive plans shall be reviewed monthly. Each plan indicates the frequency of team review. All
     references to “days” mean calendar days unless specifically state as “program days.” The
     person’s ISP Team must review all behavior plans and document the review on the monthly
     status report. A summary or status report of the behavior support program review meeting shall
     be included in the individual’s record as part of the ISP. Changes can be approved at review
     meetings. All monthly status reports will be submitted to the Behavior Support Committee for
     review. If substantial changes are made to a program, which change or add aversive procedures,
     the formal approval process must be followed and the revised program must be submitted for
     Behavior Support Committee and Human Rights Committee approvals.


K.   NON-AVERSIVE BEHAVIOR GOALS/PROGRAMS:

     Warren County DD Behavior Support Committee requires only Aversive Interventions to Target
     Behaviors that are of ‘Health and Safety’ concerns to self and/or others be addressed through
     the Behavior Support and Human Rights Committees. We refer to these as Behavior Support
     Plans. Non –Aversive Interventions to behavioral concerns that are not ‘health and/or safety’
     concerns are addressed at the Interdisciplinary Team level. We refer to these as Behavior Goals.
     It is highly recommended and ‘best practice’ that the team gather collateral as outlined on page 4
     of this procedure, the Behavior Support nine (9) point outline. These Behavior Goals/Programs
     are to be reviewed every 90 days by the Interdisciplinary Team.


L.   EXAMPLES OF APPROPRIATE STAFF/INDIVIDUAL INTERACTIONS THAT ARE EXPECTED
     OF EMPLOYEES.

     1.      Interactions and speech that reflect respect, dignity, and a positive regard for the
             individual.
     2.      The setting of acceptable behavioral limits for the individual.
     3.      The absence of group punishment.
     4.      The absence of demeaning, belittling or degrading speech or punishment.
     5.      Staff speech that is even-toned made in positive and personal terms and void of
             threatening overtones or coercion.
     6.      Conversations with the individual rather than about the individual while in his presence.
     7.      Respectful of the individual’s privacy by not discussing the individual with someone else
             who has no right to the information.
     8.      The use of people first language instead of referring to the individual by trait, behavior, or

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             disability.

M.   AVERSIVE TECHNIQUES:

     Behavior support programs using aversive techniques must use the least restrictive and most
     effective strategy. Data should be included in all aversive plans that show that positive and less
     aversive teaching and support strategies were ineffective. Behavior programs will be integrated
     into an individual's plan (IP) and reviewed as part of the entire Individual Service Plan (ISP), this
     will require coordination among all persons providing services.

     Aversive strategies should be used with great caution. In circumstances where aversive
     procedures are deemed the only appropriate methods for protection of the individual or others,
     there must be strict adherence to the safeguards protecting human rights and dignity. Critical
     components in determining whether appropriate safeguards exist include:

     1.      Written informed consent has been obtained.
     2.      All of the individual’s rights have been preserved in accordance with the DD Bill of Rights.
     3.      There are no medical or psychological contradictions to the planned procedure.
     4.      There has been strict adherence to requirements of all levels of review.
     5.      Photos of physical intervention will be included in all behavior support plans.

     These procedures must receive prior approval by the person/guardian and his or her ISP Team,
     Behavior Support Committee and Human Rights Committee before implementation. Aversive
     interventions should be used only in those situations in which withholding them would be contrary
     to the best interests of the individual.

     Aversive strategies should be used as part of a person-centered planning process only after
     positive and general strategies alone have been demonstrated to be ineffective. This does not
     mean that the entire hierarchy of strategies actually be implemented over a period of time but that
     the less restrictive procedures have been carefully considered through the assessment process.

     1.      Comprehensive behavioral/psychological assessment results are reviewed.
     2.      The person’s ISP Team approves use of aversive program as part of a person-centered
             planning process.
     3.      Informed Consent form signed.
     4.      Behavior support program and supporting documentation (i.e. “package”) forwarded to
             Behavior Support Committee for approval.

                           a. If approved, Behavior Support Committee notifies the person’s ISP Team
                              and forwards package to Human Rights Committee for approval. The only
                              clarification requests that will be submitted and still approve a plan will be
                              clerical issues.
                           b. If not approved, the Behavior Support Committee outlines its concerns in
                              writing on a clarification request form and returns the plan to the Behavior
                              Specialist for corrections/revisions, etc.
                           c. The Behavior Specialist will revise/correct/collect missing information and
                              re-submit the plan to the BSC for approval.

     5.      Human Rights Committee reviews behavior plan and supporting documentation.

                    a. If approved, Human Rights Committee notifies the Behavior Support
                       Chairperson. The plan can be implemented once all staff are in-serviced. The
                       HRC Chairperson will send the approval form to the BSC Chairperson who will
                       notify the state of the aversive plan.

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                   b. If not approved, the Human Rights Committee outlines its concerns in writing
                      on a clarification request form and returns the plan to the Behavior Specialist
                      for corrections/revisions, etc.
                   c. The Behavior Specialist will revise/correct/collect missing information and re-
                      submit the plan to the BSC for approval. The Behavior Specialist will then re-
                      submit the plan to the Behavior Support Committee, then once it has been
                      approved, and it will go to the Human Rights Committee.
                   d. The Behavior Specialist must give the staff in-service form to the Behavior
                      Support Chairperson by noon the day following the Human Rights Committee
                      meeting approving the plan.
                   e. The HRC Chairperson will send the approval form to the BSC           Chairperson
                      who will notify the state of the aversive plan.
                   f. The plan can be implemented once the staff in-servicing is complete.

     6.      Data is collected.

     7.      The individual’s team reviews the progress of the plan each month and submits that
             progress to the Behavior Support committee.
     8.      Anytime the plan is reviewed (i.e. monthly) or changed, status reports are completed and
             provided to the person receiving services, or his/her guardian if the person is over 18
             years of age, or parent or guardian if the person is under 18 years of age. If the person
             resides in a residential facility, status reports shall also be provided to the residential
             provider.

     9.      The plan (#AGF-035) should be reviewed/updated annually along with:

                    a.        the assessment AGF-123 (updated/reviewed)
                    b.        an updated physicians order for medication
                    c.        an updated Psychotropic Medication Information Sheet #AGF 131
                    d.        new staff in-service documentation sheet # AGF –110
                    e.        an updated Replacement Behavior Methodology # AGF –130
                    f.        an updated Data Collection Form # AGF-122
                    g.        an updated Informed Consent # AGF-047

N.   REQUIREMENTS FOR RESTRAINT AND TIME-OUT

     The use of restraint and time-out, because of their possible adverse effects of health and safety,
     shall require additional oversight by the department. As used in this Procedures/guidelines, the
     following definitions shall apply:

     1.      “Restraint” means any of these following:

                    a.        “Chemical Restraint,” which means a prescribed medication for the
                              purpose of modifying, diminishing, controlling, or altering a specific
                              behavior. “Chemical Restraint” does not include the following:
                    b.        Medications prescribed for the treatment of a diagnosed disorder as
                              found in the current version of the American Psychiatric Association’s
                              Diagnostic and Statistical Manual (DSM);
                    c.        Medications prescribed for the treatment of a seizure disorder.

     2.      “Emerging Methods and Technology,” which means new methods of restraint or
             seclusion that create possible health and safety risks for the individual, including methods
             of technology that were not developed prior to the effective date of this policy.


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     3.      “Manual Restraint,” which means a hands-on method that is used to control an identified
              behavior by restricting the movement or function of the individual’s head, neck, torso,
              one or both limbs or entire body, using sufficient force to cause the possibility of injury.

     4.      “Mechanical Restraint,” which means a device that restricts an individual’s movement or
             function applied for purposes of behavior support, including a device used in any vehicle,
             except a seat belt of a type found in an ordinary passenger vehicle or an age-appropriate
             child safety seat.

     5.      “Time Out”, which means confining an individual in a room or specific ‘area’ and
             preventing the individual from leaving/exiting the room or area. This would include
             applying physical force or by closing a door or other barrier, including placement in such
             a room/area when a staff person remains in the room/area with the individual and
             prevents an exit.

     Prior approval from the Director of ODODD must be obtained before using the following methods
     of restraints:

     a.      Any emerging methods and technology designated by the director of ODODD as
             requiring prior approval; or

     b.      Any other extraordinary measures designated by the director of ODODD as requiring
             prior approval, including brief application of electric shock to a part of the individual’s
             body following an identified behavior. (This rule is required by OAC 5123:2-1-02.)

     Restraint or time-out shall be discontinued if it results in serious harm or injury to the individual or
     does not achieve the desired results as defined in the behavior support plan.

     Any use of restraint or time-out in an unapproved manner or without obtaining required consent,
     approval, or oversight shall be reported as a major unusual incident pursuant to Rule 5123:2-17-
     02 of the Administrative Code.

     Any use of restraint or time-out that results in an injury that meets the definition of a major
     unusual incident or an unusual incident shall be reported as such pursuant to rule 5123:2-17-02
     of the Administrative Code.

     Within five working days after local approval of a behavior support plan using restraints or time-
     out, the county board or provider shall notify the department by facsimile or other electronic
     means in a format prescribed by the department. Upon request by the department, the county
     board or provider will submit any additional information regarding the use of the restraint or time-
     out.

O.   MEDICATION

     1.      Psychotropic medications can be prescribed for psychiatric conditions and for
             behavioral control. Persons who receive medication for behavior control or for whom
             medication is being considered, should have a person centered planning process to
             determine if alternative behavioral strategies would be appropriate.

     2.      The prescribing physician must be involved with the interdisciplinary process. This does
             not mean that the physician must attend the person’s ISP Team meetings. However, the
             Supervising RN, Service Coordinator, Residential Provider/designee will be in regular
             contact with the physician so that progress is monitored. The residential provider will
             provide    the   individuals   Service    Coordinator     documentation      of    these

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                  appointments/medicine reviews quarterly. All ISP Team members are informed of the
                  circumstances, which affect an individual’s behavior.

     P.   CHEMICAL RESTRAINTS

          1.      How to identify chemical restraints
                  a.      ODODD defines a chemical restraint as:
                         “A prescribed medication for the purpose of modifying, diminishing,
                          controlling, or altering a specific behavior. “Chemical restraint” does not
                          include the following:
                  c.      Medications prescribed for the treatment of a diagnosed disorder as found in the
                          current version of the American Psychiatric Association’s Diagnostic and
                          Statistical Manual (DSM)

                  d.      Medications prescribed for the treatment of seizure disorder

Inasmuch as this definition may not permit a sufficiently reliable determination regarding what is or is not
a chemical restraint, this document offers guidelines to aid in the identification of chemical restraints.

2.        Indications that chemical restraint may be present. If one or more of the following conditions are
          observed, this may indicate that chemical restraint is being employed.

                  a.      Uses of PRN psychotropic medications will usually be viewed as
                          “chemical restraints,” when these medications are used primarily to suppress
                         maladaptive behavior. However, PRN medications prescribed in order to reduce
                         anxiety and thus help persons undergo medical and/or dental procedures will not
                         be considered as “chemical restraints.”

                  b.     When a medication is prescribed solely for the purpose of Behavior Control, this
                         will be viewed as an instance of chemical restraint. This includes circumstances in
                         which medication is prescribed exclusively for target problems in the absence of a
                         psychiatric diagnosis that could be associated with the target problems. Examples
                         of target problems include but are not limited to the following:

                                  1.   Agitation or aggression
                                  2.   Uncooperativeness
                                  3.   Wandering
                                  4.   Fidgeting or motor over-activity
                                  5.   Social intrusiveness
                                  6.   Self Injurious Behavior


                  c.     Chemical restraint may also refer to instances in which a psychotropic medication
                         (or combination of medications) is prescribed at dosage levels that are deemed
                         to be excessive or that interfere with the person’s ability to participate in services,
                         provided that appropriately qualified professionals have made these
                         determinations.

In summary, it is necessary to consider the purpose or targets for a medication in order to determine
whether it is or is not a chemical restraint. If a medication is prescribed exclusively or primarily for
behavior control, then that medication is probably a chemical restraint. On the other hand, if a medication
is prescribed to treat an underlying disorder and thus to improve the person’s ability to function, it is
probably not a chemical restraint.

3.        Requirements pertaining to the review of the proposed use of chemical restraints.                When
          chemical restraint is used, the following requirements must be satisfied:

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          a. The individual or the guardian must provide informed consent for the use of chemical
             restraint.
          b. There must be a behavior support plan that addresses the target behaviors that the
             medication aims to decrease. The principle here is that medication should not be the
             sole treatment for the behavior problem.
          c. The behavior support plan must be reviewed and approved by the appropriate support
             and human rights committees.
          d. The human rights committee, as noted, must notify ODODD within five working days
             after approval previously.

4.   Regarding the content of a plan containing chemical restraint, the following elements should be
     present on the BSP.

          a. There must be evidence that a Registered Nurse or other appropriately
             qualified health care professional has assessed the safety of the
             chemical restraint, including possible adverse side effects.

          b. There must be documentation of ongoing communication between the
             Prescribing physician and a member of the person’s team. The names of the physician
             and the person responsible for communicating with the physician should be included in
             the “Staff Involved” section of the Behavior Support Plan (BSP).
          c. There should be description of the type of data that will be used to
             Evaluate the need for chemical restraint. In practice, this will often involve some
             measure of the frequency and/or intensity of the target behaviors for the medication. The
             target behaviors should be identified via collaboration with the prescribing physician.

          d. If a psychotropic drug is prescribed for an individual, agency form AGF- 131 is required
             to be completed by the prescribing physician indicating the reason for its use.

Q.   BEHAVIOR SUPPORT PLAN APPROVAL PROCESS

     1.      The Behavior Support Plan supporting documentation will be submitted to the Behavior
             Support Chairperson the Friday prior to the Behavior Support Committee (BSC) meeting
             (3rd Thursday of the month). At a minimum, the supporting documentation will include:

                     a. Behavior Support Plan Summary Sheet for Aversive Behaviors
                     b. Behavior Support Plan Documentation Sheet (AGF122)
                     c. Plan Status Form (AGF046)

     2.      The Behavior Specialist will present the plan to the BSC. The Behavior Support
             Committee will utilize the Behavior Support Committee Initial-Annual Review form (AGF
             037). It is possible that the plan be approved but the BSC would like clarification on some
             issue. In this case the Behavior Support Committee Clarification Request Form (AGF
             125) will be required to be answered. The plan will not be approved until the clarification
             form is complete/answered.

     3.      If the plan is approved, it will be forwarded to the Human Rights Committee for final
             approval. The Human Rights Committee will utilize Human Rights Committee Meeting
             Minutes Form (AGF 048)

     3.      If the plan is not approved the individual’s team shall meet and change the plan to meet
             the required specifications within 5 working days. The author will then resubmit the plan
             to the Behavior Support Committee for approval. The plan is then forwarded to the
             Human Rights Committee.

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R.   CRISIS INTERVENTION

     A crisis is an unexpected emergency, which necessitates an immediate response to protect
     individuals from injury or prevent property damage. If a “crisis” behaviors continue to occur. The
     first step should be to implement a person centered planning process. During that process, the
     need for a behavior plan may be discussed. The following strategies are listed in order of
     increasing restrictiveness. If a situation demands an aversive crisis response, the staff member
     involved must hold a current certification in a physical intervention technique (i.e., CPI).

S.   CRISIS INTERVENTION STRATEGIES

     1.      Alteration of environment-moving materials, objects, furniture, people, etc. to end the
             behavior.

     2.      Non-physical intervention-distraction through gestural redirection, calling an individual’s
             name, use of loud noise to interrupt, etc to end the behavior. Redirection, calming or
             relaxation procedures, problem solving, and establishing boundaries are also non-
             physical interventions. Reducing the staff/individual ratio.

     3.      Manual restraints-A behavior may be interrupted by having a staff person(s) physically
             hold an individual to prevent the behavior, if the behavior is destructive to self or others.

     4.      Emergency relocating of services- A person may have services relocated but may not be
             removed from county board services.

     5.      Emergency Placement in a Time Out room is prohibited.

T.   INCIDENT REPORT REQUIREMENTS

     1.      Crisis events must be carefully documented. Incident reports (AGF-028) should be
             completed whenever an atypical behavior occurs and for which no formal behavior plan
             exists. The completed form will be forwarded to the immediate Supervisor for further
             action and for tracking purposes.

     2.      All “Major Unusual Incidents” (MUI:OAC 5123:2-3-26) must be reported immediately to
             the Investigative Agent’s Office. A written report must be submitted to the Investigator
             within 4 hours. (See Warren County Board of DD Policy Manual for further information
             concerning Unusual Incidents).

     3.      “Neglect” means failure to provide goods and services necessary of the individual to
             avoid physical harm. This includes, but is not limited to, lack of or failure to implement a
             behavior plan and inappropriate application of behavior intervention:

     4.      Crisis Intervention Training-Staff who engages in crisis intervention procedures should be
             properly trained in implementing the crisis intervention plan.

U.   GENERAL INTERVENTION STRATEGIES TO PREVENT OR INCREASE BEHAVIOR

     1.      General intervention strategies are those teaching strategies or planning processes,
             which may be used to increase or decrease behaviors that can be implemented without
             prior committee approval. This category of strategies includes positive reinforcement,
             simple correction procedures, modest penalties, and modifying the environment to
             increase choice and control by the individual.

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      2.   Some general intervention strategies require that staff receive specialized training. The
           person’s ISP Team must monitor those strategies and accurate data must be recorded if
           they are to be used most effectively. Chronological age of the individual, frequency and
           duration of the intervention, and specific regulatory restrictions should be considered
           before categorizing any interventions.

      3.   The following two sections list several strategies, which could be categorized as “general
           intervention strategies.”

V.    PREVENTION AND BEHAVIOR SUPPORT STRATEGIES

     1.    Many disruptive behaviors can be reduced or eliminated by giving the individual more
           choice and control in his/her life through person-centered planning and by scheduling
           interesting and meaningful activities in a positive environment.

           Example of prevention and behavior support strategies:

           1.      Giving an individual option to choose from in all activities and areas of life.
           2.      Meeting individuals’ basic needs (including the need for a varied and interesting
                   program, opportunity for exercise, “breaks”, etc.)
           3.      Providing developmentally and age appropriate activities and expectations.
           4.      Developing a positive, reinforcing and supportive atmosphere.
           5.      Developing and maintaining good rapport.
           6.      Developing a caring attitude on the part of staff.
           7.      Developing an effective communication system that helps each individual
                   express wants, needs and feelings.
           8.      Providing ample opportunities to choose preferred activities or items.
           9.      Ensuring consistent and adequate communication between the individual and
                   staff, and home and work.
           10.     Controlling voice volume (loudness, softness).
           11.     Implementing environmental changes (or changing the physical environment of
                   the individual; e.g., moving furniture, painting an area, reducing noise, changing
                   location of peers, brightening work area, etc.).
           12.     Providing verbal and other forms of praise for appropriate behaviors.
           13.     Reviewing staff behavior to ensure it is not part of the problem.
           14.     Knowing and respecting the individual’s likes and dislikes, strengths and needs,
                   and personal goals.
           15.     Being aware of medical conditions that might account for inappropriate
                   behaviors.
           16.     Maintaining consistent routines with the ability to be flexible when needed.
           17.     Providing simple correction.
           18.     Providing consistent and calm intervention.
           19.     Helping the person to develop and maintain friendships and other relationships.

W.    STRATEGIES TO INCREASE BEHAVIORS

      1.   All staff that has direct contact with individuals is encouraged to develop and use an array
           of positive planning and teaching strategies. Planning can result in consumer-driven
           services and supports based on individual’s choices and preferences. Plans based on
           individual choice are most likely directed toward positive activities.

      2.   Planning and teaching strategies can range from simple actions by the service provider
           directed toward the individual to informal oral contracts between the service provider and

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           the individual to written formal programs specifying the detailed expectations to be met
           for rewards to be earned. Positive programs are most effective when they clearly define
           behaviors and include a variety of meaningful and relevant reinforcers. Very frequent
           rewards may be necessary for individuals who do not have the capability to make time-
           delayed connections between their behavior and the rewards. Care should be taken to
           ensure that rewards are meaningful and relevant to the individual. If there is a question
           about whether or not a procedure could be aversive to an individual, the Behavior
           Support Committee and Human Rights Committee should be consulted.

           Examples of strategies to increase behavior:

           1.      Positive reinforcement
           2.      Errorless learning
           3.      Forward/backward chaining
           4.      Shaping/fading
           5.      Modeling/imitation
           6.      Systematic use of prompts.
           7.      Rehearsal
           8.      Token economy without response cost.
           9.      Self-management techniques, e.g. having the individual record his/her own
                   behavior frequency.
           10.     Contracts with positive consequences.
           11.     Group contingent reinforcement.
           12.     Participating in chosen activities.
           13.     Spending time with a chosen friend.

X.   STRATEGIES TO DECREASE BEHAVIORS

     1.    In addition to using positive strategies to increase behavior, it may be necessary to use
           strategies to decrease behaviors that are dangerous to an individual or others. The
           general strategies listed below are not typically classified as aversive procedures.
           Whenever strategies to decrease a behavior are being considered for use, the least
           restrictive strategy, which is thought to be most effective, shall be used. Many of the
           strategies listed in this category are frequently used for classroom or group management.
           The person implementing the strategy must be familiar with procedures for and potential
           outcomes of their use.

Y.   STANDING PLAN

     1.    Plans for crisis intervention does not, and may not, include a standing behavior plan of
           aversive nature. The Behavior Support Committee considers a plan that has no
           documented behavior activity for more than 6 months to be a STANDING PLAN, which is
           prohibited by state rule.

     2.    If the individual has a history of behavior that is cyclical, and it can be shown predictably
           that aversive behavior occurs according to certain calendar events, then, with committee
           approval, the plan can continue.

Z.   DISCONTINUE A PLAN

     1.    Upon review, if an approved aversive behavior plan reflects 6 consecutive months with
           no data to support that any aversive interventions have been used, the behavior support
           committee should suggest that the team meet to discuss discontinuing the plan. The
           Behavior Specialist should attend the Behavior Support Committee meeting and submit

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                the evidence to support the request to discontinue a plan. This evidence should also
                include meeting minutes and the individuals/guardians consent.

        2.      The Behavior Support Committee must approve discontinuing a Behavior Plan.
                If the behavior, for which the plan was originally written, has been occurring for the past 6
                months, without the use of aversive interventions, the team should create a behavior goal
                to address the behavior. That goal would be included in the individuals ISP. The
                Individuals Service Coordinator will amend the ISP. If after being discontinued, the
                individual displays the targeted behaviors, and the staff cannot re-direct or the behavior
                threatens the health & safety of the person or others, crisis prevention intervention (CPI)
                techniques should be used. A Behavior Incident reports should be written if CPI is used.
                If the behavior again begins to be viewed as a consistent predictable aversive behavior,
                then a Behavior Support plan may again be necessary.

AA.     OHIO DEPARTMENT OF DD OVERSIGHT OF BEHAVIOR PLANS

       1.       The department shall provide oversight of behavior plans, policies, and procedures as
                deemed necessary to ensure individual rights and the health and safety of the individual.

       2.       The department shall select a sample of behavior support plans for additional review to
                ensure that that plans are written and implemented in a manner that adequately protects
                individuals’ health, safety, welfare, and civil and human rights. These reviews may be
                conducted by department staff designated by the director of ODODD or by any qualified
                entity selected by the department.

       3.       The department shall take immediate action as necessary, to protect the health and
                safety of individuals served. Such action may include, as appropriate, the following:

                a.      Suspension of any behavior support plan(s) not developed, implemented,
                        documented, or monitored in accordance with paragraph (J) of OAC 5123:2-1-02
                        or where significant trends and patterns in data suggest the need for further
                        review. When a behavior support plan is suspended, the department shall ensure
                        that a new behavior support plan is developed and implemented in accordance
                        with paragraph (J) of OAC 5123:2-1-02.

                      c. Technical assistance in the development of a new behavior support plan.
                      d. Referral to the major unusual incident, licensure, or accreditation units of the
                         department or to other state agencies or licensing bodies.

4.     The department shall compile information about the use of behavior supports throughout the state
       and share the results with county boards, providers, advocates, family members, and other
       interested parties. The department shall use the information to study and report on patterns and
       trends in the use of behavior supports, including strategies for addressing problems identified.

5.    By the effective date of this rule, the department shall establish a behavior support advisory
      committee made up of persons knowledgeable about behavior support and representatives of
      groups that have expressed an interest in the application of behavior support as specified in
      paragraph (J) of OAC 5123:2-1-02. The Behavior Support Advisor Committee shall advise the
      department in the following matters:

      Trends and patterns in behavior support methods reported to the department:

        a.      Technical assistance needs throughout the state;


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      b.   Behavior support issues raised by or referred to divisions or units of the       department;

      c.   Plans for improving the quality of behavior support throughout the state;

      d.   Any other pertinent issues related to implementation of this rule.

BB.   BEHAVIOR SUPPORT PROCEDURES

1.    REFERRAL TO THE BEHAVIOR SPECIALIST

      a.   Referrals for Behavior Supports should be completed utilizing the Behavior Supports
           Consultation Request form (AGF-065) or the result of Behavior Incidents form (AGF-028).
           Referrals should include baseline data describing target behavior, if possible.

      b.   Completed referral forms should be routed to the Director of Quality Assurance. The
           assigned Behavior Specialist will make an initial contact on the referral within 5 working
           days of receipt of the referral.

      c.   Behavior Specialist will case note the date and activity of initial contact.

      d.   Behavior Specialist will document any recommendations to the team on the Behavior
           Incident Follow Up Report form (AGF-119).

B.    BEHAVIOR ASSESSMENT

      a.   Behavior Assessments (AGF-123) contains in depth information regarding the individual’s
           life and activities. It should accurately reflect the results of information provided,
           researched and observed regarding the individual and the specific behavioral concerns.

      b.   The Behavior Assessment (AGF 123) should be completed by the Program Instructor
           and/or Residential Provider with assistance/input from the Behavior Specialist with the
           input from the rest of the interdisciplinary team. This should be done after medical
           information, observation of behavior(s), baseline information is obtained.

      c.   A Behavior Assessment of a challenging behavior refers to finding out whether there is a
           pattern of differences in the occurrence of the behavior across different settings, people,
           time of day, activities, etc. If there is a difference across, say for example, the activities a
           person is asked to do, and then a reasonable assumption is that there is something about
           the activities, which is signaling the person to do (or possibly not do if the behavior
           decreases) the challenging behavior.

      d.   The interventions possible for a behavior assessment finding would be to eliminate the
           activity if it is practical and not a needed habilitation activity, modify the activity to make it
           more acceptable to the person or withdraw the activity temporarily and then reintroduce it
           gradually making it as fun or rewarding as possible.

      e.   The signals or cues one finds in a structural analysis are related to the functional
           analysis. These are actually signals that certain motivating outcomes are now available
           (or unavailable) to the person so he may choose to do (or stop doing) a related behavior.
           Another intervention strategy is to rearrange the outcomes so that the signals or cues no
           longer are associated with a desired outcome when the behavior occurs. Thus, the cue
           no longer has a functional meaning and the behavior should decrease.



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      f.     The Behavior Assessment is used to determine what the person is getting by doing the
             behavior in most situations.

      g.     Note that the function of the same behavior may be different across different settings,
             people, etc. so motivating factors need to be looked at along with the structural cues.

             1.      Methods for doing assessment include interviewing the person, people who
                     know the person well (three or more, if possible), observing the person across
                     several settings for a number of days and manipulating the situations to change
                     the cues and suspected motivation outcomes to see what effect it has on the
                     person’s behavior. Generally, the interviews are the first step in the assessment.
                     Based upon questions about differences in the behavior across situations and
                     the typical things a person receives for the behavior in those situations, one can
                     come to some good guesses as to what the cues and motives might be.
                     Observation and environmental manipulation strategies can be used to test
                     guesses.

              2. The assessment process is an ongoing process. If the Behavior Support Plan is
                 not effective, the assessments should be reviewed and possibly revised or
                 amended. The previous assessment should be explored to determine its
                 accuracy, and obtain additional information if needed. The Behavioral Analysis
                 Interview Form should be reviewed by the Behavior Specialist together with the
                 Program Instructor/Residential Provider/Service Coordinator annually in
                 preparation for new plan development and should reflect the current status of this
                 individual including the current medications being taken.
CC.   BEHAVIOR SUPPORT PLANS:

              1. The Behavior Specialist is responsible for ensuring that a coordinated Behavior
                  Support Plan (AGF 035) is in place and part of the individuals plan for their area of
                  service.
              2. Behavior Support Plans (AGF 035) with any aversive supports will be written by
                  the Behavior Specialist with input from the rest of the individual’s interdisciplinary
                  team.
              3. Behavior Support Plans should be put into place upon approval of Behavior Support
                 Committee and Human Rights Committee.
              4. Program Instructors, and Residential Providers will ensure that all information
                 regarding the implementation/progress of behavior supports and collected and given
                 to the Service Coordinator. This status report information will be sent to the Service
                 Coordinator for review and dissemination to the rest of the team. The information
                 will then be sent to the Director of Quality Assurance.

DD.   REPLACEMENT BEHAVIOR METHODOLOGY:

              1. The Behavior Specialist is responsible for ensuring that a coordinated Replacement
                 Behavior Methodology (AGF 130) is in place in the individual’s plan for their area of
                 service. This Replacement Behavior Methodology will be created with assistance
                 from the individual’s team members.
             2. Based on the results of the Behavior Assessment and Interview process, a
                 Replacement Behavior Methodology (AGF 130) should be created by the Program
                 Instructor & Residential Provider and included in the ISP under the service area it is
                 applicable to.
             3. The Replacement Behavior Methodology (AGF 130) should be documented by the
                 ASP /Residential Staff and monitored by the Program Instructor/Service
                 Coordinator. Progress will be reported to the Service Coordinator, Parent, Guardian,

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                Residential Provider based upon the decision of the individuals interdisciplinary
                team.

EE.   AVERSIVE PLAN REVIEWS:

      1.   Aversive plans will be reviewed monthly. The Behavior Support plan will indicate how the
           review will take place (i.e., if the team will meet, just receive an update, telephone
           conversations, etc). At the monthly review, AGF 046, AGF 121 & AGF 122 will be
           utilized. Behavior Support Plan Documentation Sheet (AGF 122) will be completed by the
           ASP/ Transportation Staff/Residential Provider/ Program Instructor or other person
           indicated in the plan and reviewed with the Program Instructor/Teacher. The Behavior
           Support Plan Summary Sheet for Aversive Behaviors (AGF 121) will be completed by the
           Program Instructor/ Residential Provider with input from the direct care staff members
           and information provided from form AGF 122. This information will be presented to the
           Service Coordinator and a Plan Status Form (AGF 046), shall be completed by the
           Service Coordinator. If the individual has a plan that is in effect in more than one service
           area (day program/residential/school) the Service Coordinator may receive more than
           one Plan Review/Status Report for the individual. If that is the case, the Service
           Coordinator will send all the reports to the team members. The Service Coordinator will
           share this review/status report with the team members (individual/parent/guardian and
           residential provider). If a chemical restraint is used, the residential provider will provide a
           copy of this to the prescribing physician. The Service Coordinator will indicate when and
           how the report was shared. The Service Coordinator will then send the original forms
           (AGF 046, AGF 121, AGF 122) to the Quality Assurance Director by the Friday before the
           Third Thursday of the month, before the scheduled monthly BSC meeting.




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DEFINITIONS

ANTECEDENT – Anything that happens prior to a behavior or event.

AVERSIVE INTERVENTION – A behavior modification/management program which employs unpleasant,
intrusive or uncomfortable stimulus. This intervention has a purpose and effect of decreasing a targeted
behavior.

AVERSIVE STIMULUS – An unpleasant, intrusive or uncomfortable stimulus that is presented
immediately and consistently as a consequence of (contingent upon) that behavior. In addition, an
aversive stimulus may also mean one, which the individual will actively work to avoid or terminate, and its
contingent removal results in an increase in behavior. Depending on the degree of unpleasantness and
intrusiveness of the particular aversive stimulus, it will be classified either a major or minor aversive
intervention.

BASELINE - The strength or level (e.g. rate, duration, latency, intensity) of behavior before an
intervention is introduced. Baseline measures should be used as a basis of comparison to assess the
effects of an intervention.


BEHAVIOR CHAIN – A procedure that involves teaching a complete sequence of behaviors that must be
performed in a particular order.

a.      Backward behavior chain – a procedure that involves teaching a complete sequence of behaviors
        that must be performed in a particular order, starting with the last step and working backward to
        the first. This procedure enables the immediate success and natural consequences to the
        completion of the task.

b.      Forward behavior chain - a procedure that involves teaching a complete sequence of behaviors
        that must be performed in a particular order, starting with the first step and working toward the
        last.


BASELINE DATA – The collection of Behavior Incident activities that may substantiate the need for
creation/development of a Behavior Support Plan.

BEHAVIOR SUPPORT - A systematic, planned intervention using manual or mechanical restraints (Note:
per rule “to prevent injury to self, others, property; Major aversives are only used if injury to self or others
may occur”). This type of restraint is used primarily for the purpose of reducing or eliminating
inappropriate behavior and is used in conjunction with teaching the individual appropriate substitute
behavior. When restraint is used, the individual should be released from restraint as quickly as possible.

BEHAVIOR SUPPORT PLAN - A design of strategies whose purpose is to address ‘target behaviors’ that
are issues/concerns regarding the health and safety to the individual or others, by using (only as a last
planned resort) aversive techniques.

                              1. Initial plan – the first and original design of strategies presented to the
                                 Behavior Support Committee regarding target behaviors necessitating
                                 the use of aversive interventions.
                              2. Revises or Amended plan – it a Behavior Support Plan needs to be
                                 changed regarding the strategies or if the target behavior changes, or
                                 any pertinent piece of the plan nerds amending, a requirement is that a
                                 new Informed Consent be obtained, and the revised plan be reviewed
                                 again by the Behavior Support and Human Rights committees.

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                            3. Annual Renewal Plan – the yearly requirement of obtaining Informed
                               Consent from the Individual, Parent/Guardian to continue a currently
                               existing Behavior Support Plan.
                            4. Monthly Review – the monthly meeting of the Behavior Support
                               Committee to review the plans status. This review explains and charts
                               the activities and responsibilities outlined in the Initial Plan and is a
                               progress report of the plan.


BRIEF CONTINGENT REMOVAL OF MATERIALS – the activity, with which the individual is involved, is
removed for a brief time (up to 5 minutes).

CHEMICAL RESTRAINT – a prescribed medication to alter an individual’s maladaptive behavior which
also has the effect of decreasing adaptive behavior to a significant extent such that it effects the
individual’s ability to learn or cope with the demands of daily living.

CLARIFICATION FORM – A form initiated by the Behavior Support or Human Rights Committees that
aides in the committee members understanding of the information contained in the documents the
committees review. If information is unclear or if further information is needed, this form is sent to the
plan author for clarification.

COLLATERAL - Information and documents required for the construction of a ‘Behavior Support Plan’.

CONSEQUENCES – what happens to a person each time (contingently) a behavior occurs? It is an
environmental event that follows each occurrence of a behavior that has the effect of increasing or
decreasing that behavior in the future.

CRISIS – an unexpected emergency, which necessitates an immediate response to protect individuals
from injury or prevent property damage.

DANGEROUS TO SELF OR OTHERS –a behavior which through its frequency, chronicity, or intensity
represents risk of temporary or permanent physical harm to self or others. This should also be judged in
context of a person’s chronological age and the activity in which the behavior occurs (e.g. outdoor play
vs. circle time, work setting vs. basketball game).

DIFFERENT REINFORCEMENT OF APPROPRIATE BEHAVIOR (DRA) - is a procedure in which
reinforcement is carefully arranged so it only follows one or more behaviors chosen because they are fully
or partially incompatible with engaging in a behavior judged to be inappropriate and therefore targeted to
reduction. This incompatibility could be physical: Such as gesturing “come over here” can’t be done with
the fist closed; counting can’t be done while screaming threats; walking can’t be done while running; or
functional: Singing can’t be done while expressing anger. Reinforcement happens whenever the targeted
incompatible behaviors occur or on some specified sampling of these behaviors

DIFFERENTIAL REINFORCEMENT OF LOWER RATES OF BEHAVIOR (DRL) – A procedure in which a
reinforcer is given at the end of a pre-specified interval if the target behavior has not exceeded the
specified limit. This maintains a behavior at a predetermined rate, lower than at its baseline or naturally
occurring frequency.

DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIORS (DRO) – delivering reinforcement when
the target behavior is not emitted for a specified period of time. Reinforcement is contingent upon the
nonoccurrence of a behavior. Behaviors other than the target behaviors are specifically reinforced.

ERRORLESS LEARNING – an instructional procedure that arranges stimuli and prompts so that only
correct responses are emitted.

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EXTINCTION – discontinuing reinforcement of a behavior previously reinforced, resulting in a decrease or
elimination of the behavior (e.g. planned ignoring or withholding of staff attention).

FADING - a procedure involving the gradual removal of prompts, reinforcement or restraints until the
person is able to respond independently.

FUNCTIONAL ANALYSIS – refers to finding out what the person is gaining doing the behavior in most
situations.

GENERALIZATION – display of a target behavior across situations, settings, activities, or with people
other than the primary trainers in training settings. Generalization could also refer to the continuation of
intervention effects beyond the point of formal intervention.

GRADUATED MANUAL GUIDANCE – a procedure combining physical guidance and fading in which the
physical guidance is systematically and gradually reduced and faded according to the individual’s
responsiveness.

INCOMPATIBLE BEHAVIOR – a behavior that cannot be performed simultaneously with another
behavior because they are functionally and physically incompatible. For example, sitting in a chair is
incompatible with running out of the room.

INTERVAL SCHEDULES OF REINFORCEMENT – a schedule in which reinforcement is made
contingent upon the passage of time before the response is reinforced. a) fixed interval (FI) schedule –
when a particular response following the passage of a constant amount of time is scheduled for
reinforcement. For example, an FI 3 indicates that reinforcement follows the first occurrence of the
response after three minutes have passed. b) Variable interval (VI) schedule – when a variable time
interval must occur prior to the reinforced response. The time interval has a specific average and usually
varies within a specified range. For example, a VI 6 indicated that an average of six minutes passed
before the response receives contingent reinforcement.

LEAST RESTRICTIVE APPROACH - that intervention into the life of an individual with developmental
disability that is the least intrusive and least disruptive to the individual, and that represents the least
departure from normal patterns of living that can be effective in meeting the individual’s needs.

MAINTENANCE - continuing the desired behavior over time by means such as gradually decreasing the
reinforcers, altering reinforcement schedules and gradually decreasing artificial prompts.

MAINTENANCE PROCEDURES – thinning reinforcers, altering reinforcement schedules and fading
artificial prompts to promote the persistence of behaviors over time under more natural conditions.

MANUAL SENSORY SCREEN FOR BRIEF PERIOD - a staff member places his/her hands over the
individual’s eyes or ears to reduce or eliminate the sensory stimulus, which is maintaining an undesired
target behavior. Manual sensory screen is limited to the auditory and visual senses and should be used
only for brief periods of time (a few seconds).

MECHANICAL BEHAVIOR DEVICE – a procedure, in which an individual is prevented from full
movement of his/her limbs and/or body for a specified period of time following the occurrence of a
dangerous behavior, uses mechanical means (i.e.: soft ties, straps, etc.). The individual does not easily
accomplish removal of the restraint independently. Generally only used after other less restrictive
procedures have been tried and manual restraint is not appropriate. A physician shall prescribe
mechanical behavior devices. (NON-CONTINGENT (CUSTODIAL) USE OF MECHANICAL
RESTRAINTS) – restricting the movement or function of any portion of an individual’s limbs, head, or
body through mechanical means as part of planned mechanical program. Mechanical restraints are

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occasionally appropriate for use non-contingently with individuals who have high rate s of SIB or present
a safety risk to themselves or others. They are typically used to prevent injury until the positive or other
behavior program components decrease the target behavior. Documentation logs should always be kept
with indications of restraint checks at least every 30 minutes. A Doctor’s order must be on file as well as
informed consent.

MECHANICAL SUPPORTS – items that are used only for the purpose of providing for an individual’s
physical safety, support, maintenance of optimal body alignment and protection, including preventing
physically handicapped individuals from falling, supporting the individual during a prescribed diagnostic or
medical procedure or transporting the individual by way of stretcher or wheelchair lap trays, splints,
braces, adapted wheelchair, sandbags, seat belts, helmets, soft ties, sheets, a sleeveless cloth jacket,
and other orthopedic devices, items, when used for mechanical support, are not considered restraints.
Qualified therapists, together with medical professionals, shall prescribe within the (individual’s plan)
mechanical supports and arrange for their provision.

MEDICATION – a natural or chemically synthesized substance which is intended to be used for the
purpose of treatment, prevention of illness or diagnostic study.

MEDICAL RESTRAINT – the use of all items or measures to inhibit, control, or limit the movement or
normal function of any portion of an individual’s body to permit treatment, promote healing, or prevent
infection. Medical restraints are not considered behavior restraints. A physician shall prescribe medical
restraints.

MODELING PROCEDURE – a stimulus control procedure that uses demonstrations or modeling to
promote an imitative response (the “show” procedure).

MONITOR - to examine an existing program on a regular basis to make sure it complies with applicable
rules. Policies, and procedures, and to take appropriate steps if compliance is not achieved.

NATURAL AND LOGICAL CONSEQUENCE – those results of behavior, which can be, described as
natural consequences because they are unplanned or necessarily follow the behavior and are its
reasonable outcome. Unpleasant outcome to a behavior, which would occur independent of any staff
involvement.

NEGATIVE REINFORCEMENT – a procedure that involves the removal of an aversive stimulus as a
consequence of a response and results in the maintenance or an increased rate of behavior. A behavior
has been negatively reinforced if it increases due to the contingent removal or reduction of a stimulus.
This procedure is sometimes referred to as escape conditioning. For example, when a child does as
asked, the adult stops nagging. The child’s behavior (doing as requested) has been negatively reinforced
by the removal of the nagging.

NON-CONTINGENT (CUSTODIAL) USE OF MECHANICAL RESTRAINTS – restricting the movement or
function of any portion of an individual’s limbs, head, or body through mechanical means as part of a
planned behavioral program. Mechanical restraints are occasionally appropriate for use non-contingently
with individuals who have high rates of SIB or present a safety risk to themselves or others. They are
typically used to prevent injury until the positive or other behavior program components decrease the
target behavior. Documentation logs should always be kept with indications of restraint checks at least
every 30 minutes.

OVERCORRECTION – A reductive procedure implemented following a behavior, which disrupts the
environment. (It consists of two basic components) 1) requiring the individual to restore the environment
to a state vastly improved over one which existed prior to the behavior which disrupted the environment;
and 2) positive practice, i.e., requiring the individual to repeatedly perform an appropriate substitute


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behavior. Over correction may involve the use of graduated guidance, It does not include simple self-
correction.

PLANNED IGNORING – Permit behavior to continue without responding, either verbally or nonverbal
9i.e. on contact).

POSITIVE BEHAVIORAL INTERVENTION – a systematic program for the purpose of increasing a target
behavior, which only uses positive reinforcers. The target behavior may or may not be a substitute
behavior for a maladaptive behavior.

POSITIVE PRACTICE – The procedure which requires the individual to actively practice correct forms of
some relevant, alternative and more adaptive behavior.

POSITIVE REINFORCER – An event, behavior, privilege, or material object that will increase the
probability of occurrence of any behavior upon which it is contingent.

PRN MEDICATION – Any medication contingently administered to manage, control or
Reduce problem behaviors.

PROMPTED RELAXATION (NO PHYSICAL GUIDANCE) – a verbal or gestural prompt to cure an
individual to display quiet, relaxed behaviors to replace agitated, disruptive, or destructive behaviors he or
she emits under certain conditions.

PROXIMITY CONTROL – a staff member moving closer to an individual whose behavior is disturbing.
Proximity can also be achieved by having the individual bring something to the instructor.

PSYCHOTROPIC MEDICATION – Mind-altering drugs that have multi-faceted purposes, that ODODD
requires physicians to specify their purpose when the physician prescribes it for an enrolled individual.

PUNISHMENT – the presentation of any consequence following a response, which effectively decreases
the frequency of that response. Examples are the presentation of an aversive event or the removal of a
positive event.

RATIO SCHEDULES OF REINFORCEMENT – a schedule in which reinforcement is made contingent
upon the emission of a number of responses before one response is reinforced. (a) Fixed ratio (FR)
schedule – when a constant number of occurrences must occur prior to the reinforced response. (b)
Variable ratio (VR) schedule – when a variable number of responses must occur prior to the reinforced
response. The number of responses usually varies around a specified average … for example; a VR6
means that an average of one of six performances is reinforced.

READY BEHAVIOR – appropriate behavior that an individual must exhibit sufficient to indicate that the
disruptive or crisis incident has passed.

REDIRECTION TO A MORE APPROPRIATE ACTIVITY – a procedure in which the individual is directed
to a more appropriate task using cues or shaping. A reinforcer is given following the performance of a
pre-specified appropriate behavior. The rationale for using this procedure to decrease behavior is that
increasing a desired behavior may produce a simultaneous decrease in the targeted inappropriate
behavior.

REPLACEMENT BEHAVIOR – the alternate appropriate behavior, which needs to be taught to the
individual. It is an appropriate behavior, which needs to be taught to the individual. It is an appropriate
behavior, which achieves the same purpose as the inappropriate behavior being targeted for reduction.



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REQUIRED RELAXATION – a technique usually involving the use of graduated guidance to teach an
individual to display quiet relaxed behaviors to replace their agitated, disruptive or destructive behaviors
she/he emits under certain conditions.

RESPONSE COST – removal of tokens, privileges or other reinforcers contingent upon the appropriate
behaviors.

RESPONSE INTERRUPTION – physically stopping, (blocking) an individual from performing an incorrect
or undesired behavior by interrupting the behavior and then redirecting to a desired response. The block
is only enough physical contact to prevent the contact of the hit or a second occurrence of a hit. The use
of response interruption should always be paired with the training of appropriate activity and/or
incompatible activity.

RESPONSE REQUIREMENT – a response requirement precedes the target behavior and is designed to
decrease, rather than eliminate an inappropriate behavior. Tasks are assigned to the individual, which
must be completed prior to engaging in the problem behavior. RR requires some degree of cooperation
from the individual and has shown potential for use in self-management outlines.

REVIEW – to examine and approve or reject a proposed program prior to implementation, and to monitor
it during implementation.

RULE REMINDERS – reminding the individual of rewards for desired behavior, and/or verbally explaining
the negative consequences of specific behaviors. This should be done in a non-threatening,
nonjudgmental manner. Rule reminders call attention or restate previously discussed rules or
expectations.

SATIATION – a procedure, in which a reinforcer that has been maintaining misbehavior is presented non-
contingently in unlimited amounts in order to reduce that behavior.

SELF-RESTRAINT OR MANUAL MECHANICAL RESTRAINT APPLIED AS A REINFORCER – some
people have or develop an unusual desire for some type of restraint. This could be a form of self-restraint
such as sitting on hands or mechanical
restraints of wearing a helmet or self-restraining with strings. In these cases, it would be possible to use
the restraint as a contingent reinforcer.

SHAPING – the systematic, immediate reinforcement of successive approximations of the desired
behavior is established.

SIMPLE REPRIMANDS – Non-resistive/non-abusive physical, gestural, symbolic, and/or verbal cues,
prompts, or instructions which indicate that a behavior which has just occurred is undesirable and should
not occur again. This procedure should always be paired with redirection. The reprimand should follow
the undesirable behavior immediately. Remember, this procedure is used primarily for cueing. Do not say
things such as, “that was stupid” or “you’re bad”. Reprimands should describe specifically what someone
has done wrong and why it is wrong (e.g., “Bill, stop throwing sand”. You could put someone’s eye out.
Dig like this, with a shovel”).

SIMPLE SELF-CORRECTION (RESTITUTION) – An individual is required to repair damage that he/she
did to the environment. This should not require the repair or cleaning of anything that the individual did
not disrupt (i.e., no over correction is involved with simple self-correction). Also, physical prompts should
only be to assist with the task if necessary, not to overcome resistance.

STATUS REVIEW - a monthly requirement of informing the individual, parent/guardian of the status of an
individual’s Behavior Support Plan.


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STRUCTURAL ANALYSIS – Refers to finding out whether there is a pattern of differences in the
occurrence of the behavior across different settings, people, time of day, activities, etc. See Behavior
Support Guidelines.

TARGET BEHAVIOR – A behavior identified by the interdisciplinary team as needed to be increased or
decreased by the use of a behavioral program.

TIME AWAY – an interruption of regularly scheduled activities so that an individual can regain composure
and be able to return to their regularly scheduled activities. Time away is usually determined by the
individual and is employed most often as an effective self-management strategy. The purpose of this
procedure is to decrease inappropriate behavior by decreasing agitation, anxiety, and frustration. Time
away should not have the effect of significantly producing avoidance of habilitative programming.

TIME OUT – A behavior modification intervention through which an individual, after displaying
inappropriate behavior, is immediately restricted from receiving positive reinforcement contingent on the
occurrence of inappropriate behavior.

    1. Inclusionary o the person remains in the immediate area, but cannot participate in the
       ongoing activity (e.g., sits in a chair at the side of the group discussion but cannot participate in
       the discussion).
    2. Exclusionary – the person is moved away from the immediate area and is excluded
       from all aspects of participation, including observation (e.g. removed from a classroom and sits in
       a chair in the hallway).
    3. Seclusionary – Individual is removed from an area to a time out room, bedroom,
       office, etc. where egress is prevented.

TOKEN ECONOMY – A contingency package. Tokens (exchangeable reinforcers) are given as soon as
possible following emission of a target response. The tokens are later exchangeable for a reinforcing
object or event. “Token reinforcers” means an object that can be exchanged at a later date for a
reinforcing item or activity.

TOKEN REINFORCER – An object that is given when an appropriate behavior occurs and which can be
exchanged at a later time for a reinforcing item or activity.

WITHHOLDING OF REUTINELY GIVEN ITEMS, MATERIALS, OR ACTIVITIES 2 – Also referred to as
loss of privileges. Involves the loss of an item, material, and/or activity that constitutes a part of the
individual’s normal school or workday. Loss of privilege involves the same basic behavior mechanics as
Response Cost, except that it employs items, materials and/or activities that were not earned by the
individual (in contrast to response cost when they were earned).




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




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                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

BEHAVIOR SUPPORT REFERRALS                                                                 SECTION 3.06



PURPOSE/GOAL:          To ensure an efficient and consistent process for processing referrals and
implementing behavioral supports.

PROCEDURE:

A. Referrals for Behavior Supports should be completed utilizing the Behavior Supports Referral form
   AGF-065. Referrals should include baseline data describing target behavior.
B. Once completed, referrals should be sent to the Director of Quality Assurance for assignment.
C. Behavior Support Specialist will complete training with all new Service Coordinators, Program
   Instructors, and Quality Assurance Specialists on data collection methods for behavior supports.
   Each Division Director will be responsible for notifying the Quality Assurance Director of new staff that
   requires behavior supports and/or data collection training. Training will be scheduled/completed
   during the new employees probationary period. Training will be documented on Behavior Supports
   Training form.
D. Completed referral forms should be routed to Quality Assurance Director. The Quality Assurance
   Director will log the date referral is received.
E. Quality Assurance Director will route the referral to Behavior Supports Specialist.
F. Behavior Supports Specialist will make an initial contact on the referral within 5 working days of
   receipt of the referral.
G. Behavior Support Specialist will document any recommendations to the team on the Behavior
   Support Specialist Report form.
H. Service Coordinator & Program Instructor are responsible for ensuring that that a coordinated
   behavior supports plan is in place in their area of service.
I. If the Interdisciplinary Team decides an aversive Behavior Support Plan is necessary, the Behavior
   Specialist will work with the team in the development of the Behavior Assessment (AGF-123) and the
   Aversive Behavior Support Plan (AGF-035).
J. If the Interdisciplinary Team decides an aversive Behavior Support Plan is not needed, but behavior
   goals should be written, the Behavior Specialist will assist the Program Instructor in writing Behavior
   Goals for the day program and the Service Coordinator and Residential Provider in writing goals for
   home.
K. All Behavior Goals should be reviewed and signed off by the Behavior specialist.
L. The Behavior Supports Specialist will write behavior Support plans with any aversive interventions.
M. Behavior Support Plans should be put into place within 30 days or sooner of the date of initial referral.
N. Program Instructors and Residential Providers will ensure that data is collected regarding the
   implementation/progress of behavior supports and is ready for review by the Behavior Supports
   Committee monthly. Service Coordinator will ensure Providers collect this data and submit it monthly.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                        Behavior Supports Referrals
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                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

      PROCEDURE FOR COMPLETING BEHAVIOR SUPPORT DOCUMENTATION                                SECTION 3.07



                               Forms for Initial Aversive Behavior Plan

AGF       028    Behavior Incident Form – Day program documentation and recording of
                 behavior – to be completed by staff members observing behavior. This should
                 be given to Program Instructor to notify the parents, guardian, and residential
                 provider the day of the incident. Transportation staff -should complete form and
                 give to supervisor to notify parents/guardian/residential provider the day of the
                 incident.
                 All Division Directors should review/sign-off and sends the original form to the
                 Investigative Agents to review. Reports then sent to Behavior Specialist.
AGF       119    Behavior Incident Follow Up Report – a response to incident(s) and meeting(s) – Behavior
                 Specialist will review incident form and respond with a follow-up report. This will include
                 suggestions/recommendations. Form will be sent to staff responsible for carrying out
                 recommendations. The responsible Division Director will sign off, a copy will be sent out to
                 the individual/parent/guardian/residential provider by the secretary of the appropriate division.
                 The original copy will be sent back to the Behavior Specialist.
AGF       065    Behavior Support Consultation Request – referral to Behavioral Specialist for consultation
                 services. – This form should be completed by a Service Coordinator/Program
                 Instructor/Transportation Staff when a behavioral concern regarding an individual is of great
                 concern, causing a disruption of programming/services or could possibly result in an aversive
                 intervention. This form should be sent to the appropriate Division Director and then the
                 original should be sent to the QA Director.
AGF       106    Universal Meeting Minutes – meeting notes resulting from earliest onset of behavioral
                 incidents. – Should be completed by the Program Instructor/Service Coordinator, or anyone
                 leading the interdisciplinary team meeting. The original minutes should be attached to the
                 Behavior Support Plan in the main file. A Sign-In sheet with approval/disapproval of plan and
                 processes should be attached.
AGF       122    Behavior Support Plan Documentation Sheet – a data collection form for Behavioral
                 incidents. To be used to collect info. for Initial Plan as well as Plan Review/Status Reports -
                 This forms should be used by ASP/Residential Direct Care/Program Instructor to document all
                 behavior incidents. From this form and the Behavior Assessment, information as to what
                 happened before/after the incident occurred. This should be used in the creation of
                 initial/annual plans and then monthly to track all behaviors. This should be submitted with the
                 monthly Status Report.

AGF       123    Behavior Assessment – in depth info. Re: Individual’s life and activities – Regardless if a
                 person requires a Behavior Support Plan, or just has behaviors that need to change, and
                 goals created, a Behavior Assessment should be completed. If the behavior crosses all
                 domains, The Behavior Assessment should be filled out by the Behavior Specialist at a team
                 meeting with input from the Service Coordinator, Program Instructor ASP/Residential
                 Provider/ Guardian/Parent/transportation staff. This assessment will be completed at an
                 interdisciplinary team meeting or residence with some of the medical/health
                 information/baseline date/ communication/ history information already completed. This
                 information is the basis of the Behavior Support Plan. If the behavior is only displayed at the
                 day program, The Program Instructor, ASP staff and Behavior Specialist should work on this
                 and the Adult Workshop Nurse should provide medication information. If the behavior is only
                 displayed in the residential setting, the Residential Provider, staff and Behavior Specialist
                 should work on this and the residential nurse should provide medication information (If this is
                 a problem, information should be sought from the Adult Workshop Nurse). If the behavior is

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            only displayed while riding transportation, the Behavior Specialist should work with the
            transportation staff on this and the Adult Workshop Nurse should provide medication
            information. From the information gathered during the assessment, a Replacement Behavior
            Methodology or goal is created. The Behavior Assessment should be reviewed/updated
            annually by the Program Instructor or Residential Provider and be presented to the Behavior
            Specialist for discussion and update prior to the annual ISP meeting.
AGF   035   Behavior Support Plan – the form for creating a Behavior Plan.- This is written by the
            Behavior Specialist. The review schedule and method of review (meeting/mailing
            information/telephone calls, etc…) must be indicated in the plan.
AGF   047   BSC Consent Form – required signature of individual, parent, or guardian. - Consent must
            be given prior to aversive behavior support plan implementation. The plan author advising the
            individual/parent/guardian of the content/risks or consequences/benefits/alternatives/ and
            possible results of not implementing any behavior support plan completes this form. This
            consent is valid for the span date of the ISP.
            If it is an initial Behavior Support Plan, the consent will be valid from date of implementation
            until the next annual ISP.
AGF   110   Documentation of Behavior Support Plan In-Servicing – verification of understanding that
            support persons are versed in method of implementation of plan - All staff responsible for plan
            implementation must be trained on plan and sign this form. The initial in servicing should be
            from the Behavior Specialist to Program Instructor/ Residential Provider/Transportation
            Supervisor. Then in turn, the Program Instructor may in-service the ASP, and Transportation
            Staff; The Residential Provider will train the Direct Care staff. The Transportation Supervisor will
            train the driver and/or aide. This training may occur prior to plan submission to BSC/HRC. If the
            Behavior Specialist chooses to wait until the plan is approved by both the BSC/HRC
            committees, the plan must be in-serviced to all staff involved no later than 12:00 p.m. the day
            following the HRC committee meeting. Once the staff has been trained, the Behavior Specialist
            must then provide the original sign in sheet to the HRC Chairperson to attach to the original
            plan. This information ( for initial plans) is then sent to the state for notification of an aversive
            plan.

AGF   037   Behavior Support Committee Initial – Annual Review – a BSC form, this form poses
            questions that must be answered re: Plan. - The BSC chairperson completes this form and all
            members will sign. This may request revisions to the plan. Additionally, a Clarification
            Request/Response Form (AGF 125) may be given to the plan author. Revisions/requests
            may or may not prevent approval of the plan.
AGF   048   Human Rights Committee Meeting Minutes – a HRC form, this form poses questions that
            must be answered re: Plan. - The HRC chairperson completes this form and all members will
            sign. This may request revisions to the plan. Additionally, a Clarification Request/Response
            Form (AGF 129) may be given to the plan author. Revisions/requests may or may not
            prevent approval of the plan. The Superintendent must sign this form. A copy of this form will
            be sent to the State for notification of an aversive behavior support plan.


                             Forms for Ongoing Behavior Plans


AGF   046   Plan Review/Status Report – a summary format of activities occurring during periods of time
            since the inception of the Initial Plan. - The Program Instructor/ Residential Provider fills out
            this form with input from direct care staff. This form is then sent to the Service Coordinator.
            The Service Coordinator then sends a copy to the individual, parent, guardian, and residential
            provider. This can be accomplished by mailing/faxing or conducting a team meeting and
            providing a copy of the form. When this form is disseminated, the date and mode of
            dissemination must be indicated on the form. The Service Coordinator sends the original
            (Along with AGF 121 & AGF 122) to the Behavior Support Chairperson and keeps a copy for
            self. This should be given to the Behavior Support Chairperson no later than the second
            Friday prior to the BSC meeting. The Behavior Support Chairperson will bring this information

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            to the BSC meeting. The BSC will review all the information, the BSC Chairperson and
            Behavior support Committee members will sign it and the original will go to the individual’s
            main behavior file, a copy to the Behavior Specialist.
            If a person has a behavior support plan that is implemented in different areas (i.e./home/day
            program) The Service coordinator should receive a plan review/status report from each area.
            After reviewing the information and dispersing it to the team members, the Service
            Coordinator will send the information to the Behavior Support Chairperson by the second
            Friday prior to the BSC meeting.
AGF   121   Behavior Support Plan Summary Sheet for Aversive Behaviors – the form used to
            summarize information required for Monthly Reviews. - This form is completed by the
            Program Instructor/Residential Provider and submitted with AGF 046. The last 6 months
            worth of information should be provided. The information for this form comes from the Data
            Collection Form - (AGF 122).

AGF   122   Behavior Support Plan Documentation Sheet – see reference in initial forms section,
            above - the ASP/Residential Direct Care/ completes This form. This is to be submitted with
            (AGF 046) and (AGF 121) monthly to the Service Coordinator who will submit it to the
            Behavior Support Committee along with monthly status report.
AGF   108   Behavior Support Committee Ongoing Plan Review – a committee checklist for approving
            or rejecting Plans. - The BSC Chairperson completes this form at the BSC monthly meeting.
            This will be attached to the individual’s information (AGF 046 & AGF 121 & AGF 122) and a
            copy will go to the Behavior Specialist and the BSC Chairperson. The original will be sent to
            the individual’s main behavior file.



                         Miscellaneous Forms

AGF   111   Behavior Support Committee Interim – an emergency review form for purposes of
            approving or rejecting a short-term Plan needed before committee can assemble. - Should an
            Aversive Behavior Support Plan need to be implemented prior to the next BSC meeting, an
            interim approval that will be in effect only until the next regularly scheduled BSC/HRC
            meetings will be granted. This form will be completed and signed by the BSC Chairperson,
            the Behavior Specialist and by the HRC Chairperson.
AGF   125   Behavior Support Committee Clarification Request Form – information is requested from
            the BSC - This form is completed at the BSC meeting by the BSC chairperson and given to
            the plan author for clarification/information regarding the plan. A response is then given by
            the requested party, signed and sent to the Director of QA. It will then presented to the BSC
            Committee at the next scheduled meeting. A Copy is kept for the Behavior Specialist and the
            BSC Chairperson then sends the BSC Chairperson The original form to the individual’s main
            behavior file.
AGF   129   Human Rights Committee Clarification Request Form – Information is requested from the
            HRC - This form is completed at the HRC meeting by the HRC Chairperson and given to the
            plan author for clarification/information regarding the plan. It will indicate if the author should
            attend the next scheduled HRC meeting, and when the information is due to the Human
            Rights Chairperson. The requested party then gives a response. A copy is kept for the
            Behavior Specialist and the HRC Chairperson. The completed original form is then sent to the
            individual’s main behavior file by the HRC Chairperson/
AGF   130   Replacement Behavior Methodology -– This form identifies the behavior to be replaced and
            the method to be used to teach the individual the replacement behavior. If a person requires
            an aversive Behavior Support Plan, a Replacement Behavior Methodology should be created.
            The Behavior Specialist creates this with input from Program Instructor/Residential Provider
            based on the individuals Behavior Assessment/ Behavior Incident Reports/Behavioral
            Analysis Interview Forms. This form should be used in identifying the targeted behavior to be
            replaced/modified and the methodology to teach the individual how to achieve the
            replacement behavior. The staff member responsible for implementation of this methodology

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                  should be indicated and they should sign on this form. This form should be referenced in the
                  ISP under the program area it is implemented in. (i.e. Adult Day Program, transportation,
                  residential).
AGF       132     Behavior Goal Sheet - This form identifies the long-term goal that the individual wants to
                  work on and the short-term goal that will assist the person in changing a specific behavior
                  concern. The behavior does not require aversive interventions; rather the individual and the
                  team will work on the desired outcome and behavior modification. The Behavior Specialist
                  will assist with the writing of Behavior Goals. The Behavior Specialist should sign off all
                  Behavior Goals after review. Based on the Behavior Assessment and team meetings, an
                  individual may only want to have a behavior goal to address behavioral issues, as there is no
                  need to resort to aversive techniques when working with the individual.




      APPROVED:


                                                                                  March 26, 2010
            Megan K. Manuel, Superintendent                                           Date




                                Procedure for Completing Behavior Support Docs.
                                                 Page 4 of 4
                                                                                                       Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

RESIDENTIAL PROVIDER CHANGE AND/OR CHANGE OF RESIDENTIAL                                          SECTION 3.08
SETTINGS OF INDIVIDUAL


PURPOSE:

This Procedure is being established to ensure that when individuals change providers or move into or out
of a residential setting that financial and program considerations have been addressed to ensure smooth,
safe, transitions and financial responsibility.

Ethical Considerations:
 Providers and County Board all understand and respect an individual’s free choice of provider and
    must make a commitment to make any transitions as smooth as possible for the individual.
 Providers shall inform the Service Coordinator for an individual when the Provider becomes aware
    that the individual has indicated he or she would like to change providers. Likewise, upon consent of
    the individual and/or guardian, the County Board will inform the current provider of a request to
    change provider. Individuals and Providers will be encouraged to give, at least, 30 days notice.
    (While this is not a requirement, safely and successfully coordinating a transition takes time and
    planning.)
 Providers shall participate and “cooperate” in the process of transitioning the services for an individual
    from one Provider to another. The County Board shall involve the Provider in the process of
    transitioning from one provider to another.
 It is never appropriate to discuss how the decision the individual has made to change providers will
    impact either provider financially.

There are four important steps in the transition process:
1. Ensuring that the receiving provider, including the direct support professionals, are clearly apprised of
   and ready to meet the individual’s needs. Direct support professionals who have worked directly with
   the individual need to be actively involved in the transition process.
   This includes but is not limited to:
   A. If the individual receives medication through medication administration, does the receiving
        provider have an adequate number of staff certified in medication administration, administration of
        food or medication per gastrostomy, jejunostom tubes and/or administration of insulin?
   B. If the individual has a behavioral support plan requiring restraint and intervention, have the staff
        been trained on the restraint required in the BSP prior to serving the individual?
   C. Is there an adequate number of trained staff to meet the supervision requirement for the
        individual and others living in the home?
2. The transferring provider must emphasize how they have managed potential health and safety risks;
   this should also include important historical information about the individual.
   Priority Considerations:
   A. Any medical conditions , medications or h eath related activities such as glucom eter
        checks, blood press ure reading, allergies or special nutritional requirements should be
        clearly outlined.
   B. Environmental impact of the new setting on the individual – example, m ore traffic on the
        street in this area of town, any access problems presented by the new setting such as a
        second story if mobility is a concern, etc.
   C. Mental health or behavioral concerns—develop cheat sheet for staff— including triggers,
        what works, what makes things worse, etc.
3. The assigned Service Coordinator must actively facilitate the transition to the receiving provider or
   setting. This includes a review of the ISP to assess any new circumstances and determine potential
   risks. It is important for the Service Coordinator to ensure the receiving provider has the current
   ISP/BSP in sufficient time to train the direct support professionals.


                Residential Provider Change and/or Change Of Residential Settings of Individual
                                                 Page 1 of 3
                                                                                                  Effective 03/10




   The Service Coordinator should be sure any information related to health and safety is clear to
   all—bolding, highlighting, etc., to help it stand out. It is important that everyone communicate and
   emphasize problems needing addressed. When concerns are received, the Service Coordinator and
   provider need to ask “Are there immediate steps needed to protect the health and safety of the
   individual?” The team should proceed very cautiously on the number of changes during the transition
   period. Where feasible, numerous changes at once should be limited.
4. The receiving provider must implement the services, monitor for concerns, and notify the county
   board when there are problems with the transition.

PROCEDURE:

A. Individual Records Checklist:
   1. The Service Coordinator will coordinate the transfer of information to new providers by reviewing
       the ‘Individual Records Checklist’ and identifying who is responsible for supplying the requested
       information.
   2. Each agency or individual identified will receive a copy of the ‘Individual Records Checklist’ with
       the due date indicated. Service Coordinator will maintain a copy for follow up.
   3. The Service Coordinator will be responsible for ensuring that the information is collected and
       transferred.
   4. The Service Coordinator will be responsible for ensuring that the miscellaneous tasks indicated
       on the ‘Individual Records Checklist’ have taken place.
   5. The Service Coordinator should schedule a meeting to discuss actual transition steps prior to
       actual transition date.
B. Scheduling the transition date/time:
   1. The time and date for the transition should be agreed to in advance. (It is not a good idea to
       make the change on a weekend or at midnight – even if that would make billing easier it is
       disruptive to individuals.)
   2. It often works well to schedule the transition after individuals have left for work on a workday.
       Exiting Provider says goodbye as individuals leave for work and then Provider agencies meet to
       exchange information, etc.
   3. It is good to do medication count with the MAR form at the time of exchange. It is best practice to
       work with pharmacy to ensure minimal medications are on site at time of transfer and arrange for
       new delivery on date new provider starts.
   4. It is good to do personal inventory for each individual at time of exchange.
   5. Fiscal Office will need to be notified at least 21 days in advance of the provider change so that
       PAWS can be changed and in place for new provider at time of transition.
C. Moving:
   1. Individuals receiving Section 8 subsidy will notify Metropolitan Housing 45 days prior to moving.
       The section 8 Request to Move Form will need to be completed, the current landlord must be
       given and 30-day notice and the landlord of the unit the Individual is moving to must complete the
       Section 8 RTA packet. The Metropolitan Housing inspection must be completed and approved
       before the new subsidy will be in effect.
   2. Individuals must give a 30-day notice to their current landlord before moving and must follow
       lease terms or accept responsibility for penalties for not following lease terms.
   3. Individuals must transfer utilities and ensure landlord knows date utilities will transfer.
   4. Individuals receiving Warren County Board of MRDD rental subsidy, prior to arranging move,
       must notify Community Resource Division at 513-695-2039. The Request for Rental Subsidy
       form must be completed and approved to ensure funding is not affected by the potential move.
   5. Community Resource Department will notify the Director of Operations when an Individual is
       moving into or out of a CHAP home. This will provide the opportunity to make any needed repairs
       while the unit is empty.

Process Breakdown Points
1. Is the information clearly communicated and clearly understood?
2. Does the new staff know and understand the service plan?
3. Have supervision levels been addressed?

                Residential Provider Change and/or Change Of Residential Settings of Individual
                                                 Page 2 of 3
                                                                                                  Effective 03/10




4. Has appropriate training occurred on behavior support plans / interventions etc?
5. Does staff understand the potential problems or risks with their new responsibilities? Has all of the
   information been shared to properly prepare the receiving team?
6. Does the change create new risks for the individual?
7. Do the county board and agency have a good plan for monitoring services and providing oversight
   following the transition?
8. Does staff know what to do when problems arise?

Planning well for a transition will reduce the likelihood of any health and safety issues arising.


APPROVED:


                                                                          March 26, 2010
Megan K. Manuel, Superintendent                                           Date




                Residential Provider Change and/or Change Of Residential Settings of Individual
                                                 Page 3 of 3
                                                                                                   Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE
PURCHASE ORDER SUBMISSION                                                                SECTION 4.00


PURPOSE:       The purpose of this procedure is to communicate to all staff the requirements for
purchase order submission.

PROCEDURE:

A. Purchase orders may be submitted at any time. The Division Director or designee may enter the
   purchase order request into the Infallible I Light program. The Division Director should make sure
   that there is money in his/her budget line for the expense. After the purchase order has been
   approved by the Division Director, it must then be approved by the Chief Financial Officer and the
   Superintendent. The Division Director or designee must wait to purchase items or services until the
   purchase order has been approved at all levels.

B. If a purchase order is submitted that is considered a then-and-now purchase order (submitted after
   the expense), the Division Director responsible for completing a form with an explanation as to why
   the purchase order is being submitted after the expense and must send that to the Fiscal Specialist.

C. All employees should allow for three (3) working days processing time for purchase orders throughout
   the month, with the exception of purchase orders of $1,000 or more. These purchase orders will
   need to be assigned a county purchase orders, and are therefore, processed at the discretion of the
   Auditor’s Office.

D. If an invoice is sent for more than the initial purchase order was approved for, another purchase order
   must be submitted to make up the difference.

E. If the purchase order is no longer needed and an allocation remains on the purchase order, a
   purchase order cancellation form should be submitted to the Fiscal Specialist.


APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                        Purchase Order Submission
                                               Page 1 of 1
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

ACCOUNTS PAYABLE                                                                            SECTION 4.01



PURPOSE:         The purpose of this procedure is to communicate to all staff the requirements that must
be followed in order to get invoices processed timely.

PROCEDURE:

A. Bill payments are made from vendor invoices, board bills, or mileage reports only. No bill will be paid
   from statements.

B. All bills must have the Division Director’s approval signature on them. The Warren County Board of
   DD purchase order number must also be written on the bill.

C. When submitting a bill for contracted transportation, supported living, mileage claims, transportation
   bus repair bills, or any other bill that needs to be calculated, a calculator tape must be attached to the
   bill.

D. Vendor forms may be submitted at any time. Please allow up to five (5) days for the Warren County
   Auditor’s Office to assign a vendor number.

E. When submitting a bill for payment, the original and two copies must be submitted.

F. When the proper procedures are not followed, the bill will be returned to the Division Director to
   complete all procedures.




APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                              Accounts Payable
                                                 Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

ACCOUNTS RECEIVABLE REQUIREMENTS                                                           SECTION 4.02



PURPOSE:        The purpose of this procedure is to ensure that all revenues received are accurately
accounted for and documented appropriately.

PROCEDURE:

A. The Fiscal Specialist in the Business Services Department documents all revenues received by the
   WCBDD.

B   The Fiscal Specialist restrictively endorses all checks “For Deposit Only” and inputs the amount of the
    check, cash, or money order into the Infallible program using the appropriate revenue account.

C. The Fiscal Specialist will print a report of the revenue account for the Warren County Auditor’s Office.
   He/she will then take the revenue and printed report to the Warren County Auditor’s Office.

D. The Fiscal Specialist will input the revenue information into the Warren County Auditor’s computer
   system. He/she will then take the revenue to the Warren County Treasurer’s Office to get a receipt
   for it.

E. The Fiscal Specialist will take the receipt from the Warren County Treasurer’s Office to the Warren
   County Auditor’s Office, where he/she will get a blue copy of the receipt. The blue copy of the receipt
   will be attached to the WCBDD’s copy of the printed report of the revenue account.

F. All revenue will be deposited within 24 hours of receipt.

The Fiscal Specialist and the Chief Financial Officer will balance the revenue with the Warren County
Auditor’s Office at each month-end and at each year-end.




APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                     Accounts Receivable Requirements
                                               Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

DATA PROCESSING                                                                            SECTION 4.03


PURPOSE:         The purpose of this procedure is to communicate to all staff the proper procedures to
follow for Data Processing requests.

PROCEDURE:

A. If an employee has a data processing concern, he/she should contact the Data Processing help desk
   to request the concern be taken care of.

B. If a Division Director wants to purchase hardware or software, he/she must complete a “Data
   Processing Board System Request” form. This form must be signed by the Superintendent. Once
   the Data Board has approved the request and a purchase order has been approved, the Division
   Director may order the desired hardware or software.

C. If a new employee starts work for the Warren County Board of DD, the division director or designee is
   responsible for filling out the proper forms and sending them to the Chief Financial Officer. He/she
   will then get the proper signatures and send to Warren County Data Processing. Forms for Data
   Processing can be found on the Warren County website.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                        Data Processing Procedures
                                                Page 1 of 1
                                                                                                      Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

INFALLIABLE UPDATES                                                                            SECTION 4.04


PURPOSE:          The purpose of this procedure is to communicate to all staff the proper procedures to
follow for the Infallible software updates.

PROCEDURE:

A. Infallible updates will be done on a daily basis for all versions of Infallible software.

B. The Fiscal Specialist or designee will do Infallible updates between 8:00 a.m. and 8:30 a.m. daily.

C. If an employee is experiencing difficulty with the Infallible software, he/she should call the Fiscal
   Specialist right away with the problem.



APPROVED:


                                                                                     March 26, 2010
          Megan K. Manuel, Superintendent                                                Date




                                                Infallible Updates
                                                   Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

INVENTORY CONTROL                                                                          SECTION 4.05



PURPOSE:

The purpose of this procedure is to reflect that the WCBDD will maintain accurate inventory records
regarding the procurement, marking, location and disposition of all WCBDD land, buildings, fixed
equipment and major moveable equipment.

PROCEDURE:

   A. All information involving the acquisition, marking, location, movement, and disposal of WCBDD
      items costing or valued at or over $1,000 are to be kept current and maintained in the Operations
      Department.

   B. All purchased materials/equipment costing $1,000 or more should have a fixed asset tag
      attached. It is the responsibility of the department purchasing the item to contact the Operations
      Director to get a fixed asset tag. The Operations Director will assign a tag and number and enter
      the information onto the inventory list.

   C. If any materials/equipment are to be transferred between departments or discarded completely,
      the Division Director must first contact the Operations Director so that he/she may adjust the
      inventory list. Only upon the recommendation of the Operations Director and the approval of the
      Superintendent or Deputy Superintendent may an item be disposed.

   D. The Chief Financial Officer will maintain the listing of depreciation for all assets. The depreciation
      will be accounted for annually on the Ohio Department of Developmental Disabilities Cost Report.


APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                             Inventory Control
                                                Page 1 of 1
                                                                                      Effective 03/10




              WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                             AGENCY PROCEDURE

ABUSER REGISTRY NOTICE                                                         SECTION 4.06


PURPOSE:        To establish a systematic means of providing each DD employee and contracting
entity a process to provide an annual written notice of conduct that may result in placement on
the Abuser Registry.

PROCEDURE:

A.     DD Employees

           1. Beginning February 1, 2005, at the time of hire, each employee will be provided
              with a written notice of conduct that may result in placement on the Abuser
              Registry.
           2. Annually each employee will complete training on the Public School Works
              Training System. Each employee will enroll in the course entitled ‘Abuser
              Registry’. Each employee will take the class annually.
           3. Each employee will acknowledge receipt of the notice by completing the class
              test.

B.     DD Contracting Entity

           1. As each contract is approved and signed, an ‘Abuser Registry – Notice to
              Employees’, will be provided to the contracting entity to give to their current
              employees.
           2. All future employees should be provided a notice at the time of hire and
              thereafter, annually.




APPROVED:


                                                                        March 26, 2010
        Megan K. Manuel, Superintendent                                     Date




                                     Abuser Registry Notice
                                          Page 1 of 1
                                                                                                     Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

WAIVER OF INSURANCE                                                                           SECTION 4.07


PURPOSE:         In accordance with the terms of the Warren County Board of Developmental Disabilities
(WCBDD) Health Insurance/Life Insurance Policy you may waive your coverage under the County's group
health, vision and dental plans. If you chose to waive all coverage (group health, dental and vision), you
will receive additional taxable cash compensation (see below for the amount). If you elect to participate in
these plans, the policy allows you to pay your portion of the premiums on a pre-tax basis. In other words,
the amount you pay for the premiums will not be subject to federal or state tax.

PROCEDURE:

A.      WAIVER OF COVERAGE

        1.       In order for you to waive the coverage, you must do the following:

                 a. You must be employed by WCBDD and be eligible for Group Health Plans
                 b. You must sign the waiver section on each Group Plan application and the agency
                    Waiver of Insurance Form
                 c. You must supply verifiable proof of other medical coverage

        2.       If you and your family waive coverage under all of the County's group health plans, you
                 will receive $50.00 per month for each month that you meet eligibility requirements. This
                 amount is taxable. The cash payment, less tax, will be included in your regular paycheck
                 on the first pay of that month. If you or your family participates in any of the County health
                 plans during the month, you will not receive cash compensation for that month.


B.      INITIATING WAIVER

        1.       A WCBDD Waiver of Insurance Form must be completed and submitted with proof of
                 other health coverage to the Human Resource Administrative Assistant within thirty days
                 of the following:

                 a. You first become eligible to participate in any of the County's group health plans.
                 b. The beginning of a new plan year or
                 c. When you become covered under another health plan and wish to waive all coverage
                    under the county's group plans.

             2. Once you have waived coverage under all County group health plans, this waiver will
                remain in effect until such time that you enroll in at least one group plan under the terms
                of that plan.

C.      CHANGE IN COVERAGE

             1. Once you begin to participate in any of the County's group health plans, you must
                continue in that plan and cannot receive additional cash compensation until the next open
                enrollment period, or an Election Change Event.


             2. An Election Change Event is:



                                             Waiver of Insurance
                                                Page 1 of 2
                                                                                             Effective 03/10




            a. A change in your legal marital status including marriage, death of a spouse, divorce,
               legal separation and annulment.
            b. A change in the number of your dependents including the birth, death, adoption and
               placement for adoption of a child.
            c. A change in your employment status or a change in your spouse or dependent's
               employment status including the termination or commencement of employment, a
               strike, lockout, the commencement or termination of an unpaid leave of absence and
               change in worksite.
            d. A change in you or your spouse's or dependent child's employment status that affects
               that individual's eligibility under a cafeteria plan or any benefit plan (including the
               County's health plan).
            e. Your dependent child or spouse satisfied or ceases to satisfy the eligibility
               requirements because of age, student status or similar circumstances.
            f. The commencement or termination of adoption proceedings.
            g. A change in you or your spouse's or dependent child' s residence that impacts their
               eligibility under the group health plan.
            h. A judgment, decree or court order resulting from a divorce, legal separation,
               annulment or change in legal custody (including a qualified medical child support
               order) that requires coverage under a group health plan for your child or foster child.
            i. Entitlement or loss of Medicare or Medicaid for you or your spouse or dependent
               child.
            j. The commencement or return from a period of absence under the Family and
               Medical Leave Act.
            k. Eligibility for COBRA coverage (or similar coverage under state law) offered by the
               County.
            l. Any change resulting from a change made under a plan of your spouse's, former
               spouse's or dependent child's employer that is listed on this form.

     3.     The Health Insurance/Life Insurance Policy does not impact the eligibility rules and
            requirements of the County's group plans. All of these plans have their own rules
            governing when you can add or drop coverage. Therefore, it is your responsibility to
            review each plan prior to making any changes.




APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                                       Waiver of Insurance
                                          Page 2 of 2
                                                                                                Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

TUITION REIMBURSEMENT                                                                    SECTION 4.08


PURPOSE:       To outline the procedure to be followed when an employee wishes to apply for tuition
reimbursement.

PROCEDURE:

It shall be the procedure of the Warren County Board of Developmental Disabilities to provide tuition
reimbursement to employees, pending availability of funds. Only full-time and/or regular part-time staff
members are eligible (substitutes do not qualify). The tuition reimbursement program affords qualified
staff members the opportunity to pursue educational goals congruent with personal growth and agency
related work.

A.     THE PROCESS FOR REQUESTING TUITION REIMBURSEMENT IS A FOLLOWS:

       1.      Applicants may apply for tuition reimbursement for no more than three courses per
               calendar year (see exception noted in Section A.7 of this procedure). Each calendar
               year, the Board will set the maximum dollar amount, which will be reimbursed per course.
               The current rate is up to $500.00 per course. Total funds expended on tuition
               reimbursement shall not exceed the amount designated in the Board’s annual budget.

       2.      Coursework submitted for approval must be ODODD/ODE hours or personal/educational
               growth that will enhance the employee’s knowledge in the field. Approved coursework
               shall be completed on the employee’s own time, (i.e. nights, weekends, personal or
               vacation time).

       3.      In order to receive approval; requests for tuition reimbursement must be submitted to the
               employee’s Division Director at least seven (7) days, but not more than 60 days, prior to
               the first day of the course. Course work, which has not been pre-approved, will not be
               reimbursed.

       4.      The applicant’s Division Director will record the date on which the request was received
               and will review the request, checking to ensure that the employee is eligible and that the
               course work meets the criteria outlined in parts “B” and “C” of this procedure. If
               approved, the Division Director will forward the request to the Chief Financial Officer. If
               disapproved, the request will be returned to the employee. The reason for the denial will
               be explained to the staff member.

       5.      In order to ensure access to funds to those taking courses later in the year, the total
               amount budgeted for tuition reimbursement for each fiscal year will be divided in half.
               One half of the funds will be set aside for the January 1st through June 30th period and
               the other half will be reserved for the period of July 1st through December 31st.

       6.      Upon receipt of an approved request, the Chief Financial Officer will determine whether
               funds are available to reimburse the course. If funds are available, the employee will
               receive a letter certifying the amount of reimbursement, which she/he will receive.
               Requests for reimbursement will be taken in order by the date on which they were
               submitted to the Division Director. If there should be more than one request with the
               same date at the point at which funds are no longer available, the tie will be broken by
               using the following criteria, progressing to each succeeding step only as needed:


                                         Tuition Reimbursement
                                               Page 1 of 3
                                                                                          Effective 03/10




      a.      Preference will be given to an applicant who has not yet received tuition
              reimbursement in the current calendar year;

      b.      Preference will be given to the employee with the greater number of years of
              service with the Board;

      c.      Any remaining tie will be broken by establishing the order of reimbursement by
              random selection. Each employee will receive a letter notifying him/her of the
              status of his/her request.

7.    If there are insufficient funds to reimburse tuition for a course to be taken during the
      January 1 through June 30 period, the request for reimbursement will be placed on a
      waiting list, pending the use of funds during the second half of the year. If tuition
      reimbursement funds remain unused on October 30th, after funds for summer and fall
      courses have been allocated, those on the waiting list from the first half of the year will be
      reimbursed in the order shown on the waiting list until either all funds have been
      disbursed, or all requests have been filled, whichever comes first. If funds are not
      available to cover the tuition reimbursement requested, employees have the option of
      taking the course without reimbursement or waiting until the next calendar year to take
      the course and re-submit a request for tuition reimbursement.

8.    If unencumbered funds should remain in the annual account for tuition reimbursement
      after October 30th, all employees will be informed of this fact. Any qualified employee
      who has taken a course which has not yet been reimbursed, or who will still take a course
      during the current fiscal year, or any employee who has taken or will take a course during
      the current fiscal year which is required for Ohio Department of DD certification or
      registration may submit a Request for Tuition Reimbursement to his/her immediate
      supervisor. Remaining funds will be allotted to applicants following the same guidelines
      as outlined in steps A.3 through A.6 of this procedure.

9.    When a request for tuition reimbursement is approved and certified, the approval and
      certification is valid only if:

      a.      The course taken is the course listed on the request form.
      b.      The course is taken at the institution as indicated.
      c.      The course is taken during the calendar period indicated.

10.   If an employee needs to change the course and/or the institution, which was approved
      and certified on the Request for Tuition Reimbursement form, she/he must submit a
      Request for Change in Course Work form to his/her immediate supervisor and receive
      his/her approval before starting the new course. The amount of reimbursement, which
      was certified, will not increase, even if the cost of the new course is higher. Changes in
      course work or institution, which are not approved in advance by the immediate
      supervisor, will not be reimbursed. If an employee needs to change the time period
      during which an approved and certified course will be taken or she/he decides not to take
      the course, the employee must inform the Chief Financial Officer within five (5) working
      days of the scheduled start of the course. If she/he wishes to take the course at another
      time, a new request for tuition reimbursement must be submitted during the time period
      outlined in part A.3 of this procedure. Failure to report such a change within the time
      frame noted above will result in the employee being ineligible for tuition reimbursement
      for one (1) year from the date that the course was scheduled to begin.

11.   If an employee withdraws from, does not complete, or does not satisfactorily complete a
      course, which has been approved and certified for reimbursement, she/he must inform
      the Chief Financial Officer of this fact. Failure to inform the Chief Financial Officer within

                                 Tuition Reimbursement
                                       Page 2 of 3
                                                                                             Effective 03/10




            five (5) working days of an incomplete or unsatisfactory completion of a course will result
            in the employee being ineligible for tuition reimbursement for one (1) year from the date
            that the course was scheduled to end.

B.   THE PROCESS FOR REQUESTING PAYMENT FOR COMPLETED CLASSES AS FOLLOWS:

     1.     Applicants should submit the following paperwork:

            a.    Proof of completion of course/class and/or:
            b.    Proof of receipt of a letter grade of “C” or above
            c.    Proof of payment for the course/class.
            d.    A completed Board Bill

     2.     Paperwork should be sent to the Chief Financial Officer.




APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                                       Tuition Reimbursement
                                             Page 3 of 3
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

TIME SHEETS                                                                                 SECTION 4.09


PURPOSE:          The purpose of this procedure is to communicate to all staff the procedures that are
expected of them in order to process payroll in the timely manner requested by the Warren County
Auditor’s office.

PROCEDURE:

A.       Every employee of the Warren County Board of DD should either have a timesheet filled out or a
         computer-documented form showing time worked for every bi-weekly period.                 These
         timesheets/forms are to be turned into the Business Services Department payroll fiscal specialist
         by the following times:

             1.   Early Intervention              12:00 p.m. on Friday prior to payday
             2.   Community Resources             12:00 p.m. on Friday prior to payday
             3.   Adult Services                  Friday prior to payday (when completed)
             4.   Transportation                  8:30 a.m. on Monday prior to payday
             5.   Administration                  12:00 p.m. on Friday prior to payday
             6.   SSA                             12:00 p.m. on Friday prior to payday

     B. The Fiscal Specialist will process the timesheets/forms in order to produce a payroll report for the
        Warren County Auditor’s office. If he/she should have any questions, they will be directed to the
        Division Secretary for the department for whom the employee whose timesheet is in question
        works. It is expected that the Division Secretary will find the answer to the question if he/she
        does not already know. The Fiscal Specialist will then record on the timesheet/ forms the answer
        given. Payroll will be processed based on the answer given.

     C. If an employee has a question/concern about his/her paycheck, he/she should address the
        question to the Division Secretary from his/her department first. The secretary may have the
        answer. If the secretary does not have the answer or the employee is not secure in the answer,
        they may then contact the Fiscal Specialist in regards to his/her paycheck.

     D. No changes can be made to payroll after 12:00 noon on the Monday prior to payday. If an error
        is discovered after that, the employee must wait for the correction to be done on the next
        paycheck.


APPROVED:


                                                                                  March 26, 2010
          Megan K. Manuel, Superintendent                                             Date




                                                Time Sheets
                                                Page 1 of 1
                                                                                                  Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

PAYCHECK/DIRECT DEPOSIT SLIP PICKUP                                                        SECTION 4.10


PURPOSE:       The purpose of this procedure is to communicate to all staff the procedures that are
expected of them in order to pick up their bi-weekly paycheck.

PROCEDURE:

   A. A Warren County Board of DD Business Services Department employee will pick up paychecks
      and direct deposit slips from the Warren County Auditor’s office on payday Friday at 7:30 a.m.

   B. Paychecks and direct deposit slips will be checked, sorted, and distributed by the Fiscal
      Specialist or designee.

   C. Checks and direct deposit slips will be distributed to the division secretaries by 10:00 a.m. on
      payday Friday. All employees may then pick them up from their division secretaries.

   D. If an employee is not able to pick up his/her paycheck or direct deposit slip, he/she may give
      permission to another person (i.e. employee, friend, family member) to pick up his/her paycheck
      or direct deposit slip. This permission must be given in writing at the time the other person is
      picking up the paycheck or may be submitted in writing prior to payday to the Fiscal Specialist. If
      an employee has not given written permission, this other person will not be permitted to pick up
      the paycheck or direct deposit slip.

   E. In order for an employee to pick up his/her own paycheck he/she must sign the form stating that
      he/she received the paycheck. It is not necessary for the employee to sign for the receipt of
      his/her direct deposit slip. If another person is present to pick up a paycheck or direct deposit slip
      (based on above stated criteria), that person must also sign the form stating that he/she received
      the paycheck or direct deposit slip.

   F.    If an employee is not present or does not pick up his/her paycheck or direct deposit slip on
        payday, the paycheck or direct deposit slip will be held in the Business Service Department safe
        until the Monday following payday. If the employee still does not pick up the paycheck or direct
        deposit slip on Monday, the check or direct deposit slip will be mailed Monday afternoon. If an
        employee does not want the check or direct deposit slip to be mailed, he/she may make
        arrangements with the Fiscal Specialist to continue to hold the check or direct deposit slip in the
        safe.



APPROVED:


                                                                                 March 26, 2010
         Megan K. Manuel, Superintendent                                             Date




                                    Paycheck/Direct Deposit Slip Pickup
                                               Page 1 of 1
                                                                                                  Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

APPROPRIATE INTERACTION GUIDELINES                                                         SECTION 4.11



PURPOSE:      These guidelines are being written to obtain and maintain consistency between all staff
members, volunteers, service providers and all enrolled individuals.

A.     APPROPRIATENESS

       1.      Appropriateness means different things to different people. What is good and
               appropriate in a home or social setting may not be appropriate in an industrial setting.
               For purposes of clarity, it might be helpful in questions of appropriateness, to liken the
               Adult Services program to some other industry, such as General Motors or Armco, as we
               model our workplace after an outside work environment. The school and classroom
               settings are modeled after typical classroom environments.

       2.      The main goal in developing Appropriate Interaction Guidelines is to give all staff
               members, volunteers and other service providers, a reference point to build on. These
               guidelines are being written to protect the dignity and human rights of all individuals in
               this program. They are derived from and based on the Warren County Board of DD
               Mission Statement and the Ohio Bill of Rights for People with Mental Retardation. In
               some cases, continued infractions of these guidelines may result in disciplinary action for
               the staff member, volunteer or service provider involved. If you feel that an exception
               should be made for any individual, please consult the Service Coordinator or Teacher for
               that individual.

B.     APPROPRIATE TOUCHING

        1.     Crisis Prevention Intervention (C.P.I.) - In a crisis situation such as aggression towards
               a staff member, another individual or significant personal property, C.P.I. will be
               implemented by trained staff members. Crisis Prevention Intervention is designed to
               deal with a crisis situation with minimal chance of harm to the individual or the staff
               member involved. If the staff member, volunteer or service provider has not had
               approved C.P.I. training and are witness to a crisis, they are asked to assist the trained
               staff by clearing the area of other individuals, ensuring their health & safety.

        2.     Any minor aversive technique (use of a CPI approved restraint, exclusionary time out
               less that 2 hours per 24 hours, etc.) requires a Behavior Support Plan approved by both
               the Behavior Support and Human Rights Committees. A Behavior Support Plan must be
               signed and accepted by the individual and/or his/her guardian. In an emergency
               situation, CPI may be used. In this case, a Usual Incident Report should be completed.

C.     HUGGING, KISSING, ROCKING, HAND HOLDING

        1.     In the work setting or classroom, the use of excessive affection or childlike interaction is
               not in the best interest of the individual. Hugging and kissing in this setting gives mixed
               signals. Unfortunately, individuals with mental retardation and developmental disabilities
               are often victims of sexual abuse. An individual may not have the physical, mental or
               emotional skills to distinguish genuine excessive affection from affection that could cause
               great harm. In protecting the dignity and safety of an individual, appropriate interaction is
               expected at all times. If a staff member feels that an exception should be made for a
               particular individual regarding the use of affection, a goal should be written to encompass


                                     Appropriate Interaction Guidelines
                                                Page 1 of 3
                                                                                                Effective 03/10




               the affection as a reward. The staff member, volunteer or service provider should contact
               the Service Coordinator or Teacher of the individual to determine appropriateness.

D.   APPROPRIATE LANGUAGE

            1. Verbal Personal Attacks - All staff members are expected to use proper tone, volume
               and content in any conversation. Yelling, name-calling, verbal humiliation or any
               derogatory comments directed towards an enrolled individual could be considered verbal
               abuse. This will result in disciplinary action toward the staff member.

            2. Nicknames (example: Honey, Sweetie-Pie, Slowpoke, etc.) - Pet names
               and nicknames used by staff in reference to an individual should be in good taste.
               Nicknames that are acceptable to the participant should be positive in nature and
               appropriate to a work setting. Nicknames that are demeaning, derogatory or non-age
               appropriate should not be used.

            3. Cursing - Everyone should refrain from using profanity in the work place, classroom or
               community outing. Sexual or religious references are inappropriate in this setting. Staff
               members, volunteers and other providers are expected to use good judgment.

            4. Appropriate Greeting - Some individuals in the building have greeting habits that are
               inappropriate. Repeated verbal greeting, waving and hand shaking could be detrimental
               as he/she moves out into the community. Consistency can encourage each individual to
               learn appropriate greetings in the work place, school setting, and out in public.

     As a rule of thumb, formally greet an individual once a day. The next time the individual attempts
     to greet you, stop and briefly explain that you greeted him/her once and once is sufficient for the
     day. If the individual greets you subsequent times during the day, do not accept the greeting.
     Either put one hand up in a stopping motion to halt the greeting or ignore the greeting without eye
     contact or a smile. This planned ignoring or hand motion may seem rude or unfriendly, but in
     reality, the individual will benefit by being more positively received in the community. Education
     by consistent response to greeting of staff members, volunteers and other providers will increase
     acceptance by the public and thus increase the individual’s success in general. Those who greet
     by shouting across the room are not greeting appropriately in this setting. The reaction to this
     should be planned ignoring, coupled with a prompt by another staff member, volunteer or service
     provider to greet someone in a more appropriate manner. This should be done informally or with
     the use of a goal.

       5.      Person-First Language - In order to ensure respect and dignity for individuals with
               disabilities, everyone should always refer to/speak to enrolled individuals using person-
               first language. Examples of person-first language include: an individual who uses a
               wheelchair, not a “wheelchair”; an individual with a behavioral concern, not a “behavior”

E.   APPROPRIATE STAFF TO STAFF INTERACTION

       1.       Physical Contact – Common, friendly, staff to staff interaction such as a pat on the back
                or handshake is very appropriate. Physical contact of a sexual nature or that, which
                could be misinterpreted as sexual, is not appropriate. Some individuals have goals in
                place involving appropriate interaction with the opposite sex. In situations involving
                horseplay and inappropriate physical contact between staff members, wrong signals may
                be given. Good judgment and common sense is expected when physical contact is made
                between staff members during work/school hours.

            2. Conversation – Staff, volunteers and other service providers must remember that
               conversation with each other is always within earshot of the enrolled individuals.
               Therefore, discussion regarding sexual issues and other sensitive topics must not be

                                     Appropriate Interaction Guidelines
                                                Page 2 of 3
                                                                                            Effective 03/10




            discussed in the workplace or school setting. It is also important not to talk about an
            individual in front of them. Confidential information should be discussed in private.

       3.   After Hours Staff/Enrolled Indiv idual Interaction - Staff members, volunteers and
            other service providers should be cautious when participating in after hours activities.
            Unfortunately, personal contact after hours could be misunderstood. Warren County
            Board of DD does not want to forbid or discourage after-hours interaction with enrolled
            individuals, but the staff member, volunteer or service provider should be aware of the
            pitfalls and take precautions. Be aware of any individual medical conditions and know
            what to do if a medical problem occurs. After-hours contact is the full responsibility of
            the staff member, volunteer or service provider if it is not a Board approved activity.




APPROVED:


                                                                           March 26, 2010
      Megan K. Manuel, Superintendent                                          Date




                                 Appropriate Interaction Guidelines
                                            Page 3 of 3
                                                                                                   Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

EXTENDED ILLNESS LEAVE (DISABILITY LEAVE)                                                   SECTION 4.12



PURPOSE:        To provide additional unpaid leave to employee’s who are physically or mentally unable to
perform their assigned duties.

PROCEDURE:

A.      REQUEST

        A request for Extended Illness Leave must be in writing and the employee’s physician must certify the
        employee’s condition, the reasons for the request, and provide a definitive return to work date.

        The employee shall be required to complete a Medical Practitioner’s Statement to justify the leave.

        The Superintendent has the sole discretion to grant an Extended Illness Leave. However, where an
        employee has a disability, which qualifies for protection under the ADA, a leave of absence may be
        considered a reasonable accommodation.

B.      RETURN FROM LEAVE

        The employee will be required to provide a statement from his or her medical practitioner that the
        employee is fit for duty and able to perform the essential functions of his or her position prior to
        returning from leave.




APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                           Extended Illness Leave
                                                Page 1 of 1
                                                                                                Effective 03/10




               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

FAMILY AND MEDICAL LEAVE                                                                 SECTION 4.13



PURPOSE:     To comply with the Federal Family and Medical Leave Act.

PROCEDURE:

A.   REQUEST

     When an employee requests Family and Medical Leave (FML) by indicating the reason for the leave
     on the Use of Leave Form or by calling in with information regarding a possible serious health
     condition:

     1.      The immediate supervisor or employee shall contact Human Resources Administrative
             Assistant immediately.

     2.      If it is a new request for which the employee has not been granted FML for the reason
             stated, the immediate supervisor should call the Human Resources Administrative
             Assistant/designee immediately and tell the employee that the leave may qualify for FML
             and that the employee will be receiving an FML Packet from the Human Resources
             Division in the near future.

     3.      The Human Resources Administrative Assistant will ensure that an FML packet is sent to the
             employee.

B.   FMLA PACKET

     1.      The FMLA Packet shall include the following:
               a.     FMLA Checklist
               b.     Request/Receipt
               c.     FMLA Notification
               d.     FML Policy (Section 4.D.01)
               e.     Medical Practitioner’s Statement
               f.     Employee’s Job Description, if applicable
     2.      The employee should be required to sign the receipt at the time the packet is given to him or
             her.
     3.      The employee is required to return the Medical Practitioner’s Statement within 15 days.
     4.      The employee may need to re-certify his/her FML if he/she is still under a doctor’s care when
             it expires. When a re-certification is necessary and the current FML has NOT expired, the
             employee may renew their leave by obtaining a doctor’s note stating that the current
             condition(s) still exist. If the employee’s FML has expired, he/she shall be given another
             Medical Practitioner’s Statement for completion.
     5.      If an employee has a chronic condition, or if leave is requested over an extended period of
             time, a new packet may be given to the employee and the doctor must complete the entire
             form every six months.
     6.      A new packet should be given to the employee for each separate serious health condition
             and the employee should provide separate Medical Practitioner’s Statements for each
             condition.

C.   EMPLOYER DESIGNATION

     If an employee’s supervisor or any administrative employee reviews a Use of Leave request form and


                                        Family Medical Leave
                                            Page 1 of 2
                                                                                                     Effective 03/10




     the reason stated for the leave could qualify as a serious health condition, the supervisor must notify
     the HR Director/designee immediately. The HR Director/designee will investigate the request for leave
     and determine if the leave should be designated as FML and/or if a Medical Practitioner’s Statement
     is necessary. If the leave qualifies, the employee should be notified orally and then be given an FML
     Packet within two days.

D.   RETURN FROM LEAVE

     When an employee wishes to return from an approved FMLA leave of absence, the employee must
     provide a statement from his or her medical practitioner that the employee is fit to return to duty and is
     able to perform the essential functions of his or her position.




APPROVED:


                                                                                   March 26, 2010
      Megan K. Manuel, Superintendent                                                  Date




                                          Family Medical Leave
                                              Page 2 of 2
                                                                                                   Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

HEALTH INSURANCE                                                                            SECTION 4.14



PURPOSE:       To maintain accurate health insurance coverage for all eligible employees.

PROCEDURE:

A.   CARRIERS

     1.        Fiserv Health has been the agency’s third party administrator for the self-insured dental and
               vision coverage since March 1, 1994.
     2.        United Health Care has been the carrier for medical and prescription coverage of the
               agency’s fully insured plan since January 1, 2007.

B.   ELIGIBILITY

     An employee’s status must be permanent, active and scheduled to work at least 30 hours per week in
     order to qualify for health benefits.

     1.        Upon hiring, enrollment forms are completed by the employee. The HR Department submits
               the forms to the appropriate insurance carrier by the 8th of the month prior to the employee’s
               effective date.
     2.        The HR Department submits all benefit changes (terminations, changes in coverage) to the
               carriers by the 8th of the month prior to the effective date of change and enters them in the
               agency insurance database.
     3.        All forms are reviewed for accuracy by the HR Department prior to submission to the carriers.
                Annual open enrollment is available to eligible employees during the month of December,
               which gives an effective date of January 1. During this time, employees may change their
               existing coverage for any reason, not only for a life event.

C.   BILLING

     1.        Annual or semi-annual purchase orders are prepared for the carriers based on current
               enrollment and estimated additions.
     2.        The HR Department generates monthly billing reports that are broken down into type and
               cost of insurance per employee in each department.
     3.        Fiserv Health sends an eligibility listing to DD monthly. The HR Department reviews the
               listings to make sure proper employees are included/excluded according to the departmental
               reports and returns it to the Eligibility Department at Fiserv.
     4.        A monthly invoice is received from United Health Care. It is reviewed and adjusted according
               to the departmental reports. The corrected invoice is submitted to the DD Fiscal Department
               for payment after verifying the amounts on the appropriate purchase orders.
     5.        The monthly numbers for the Fiserv invoice are entered onto the blank form provided by
               Fiserv. After calculating the amounts due, the invoice is submitted to the Fiscal Department
               for payment.

D.   COBRA

          1.   When an employee terminates health benefits, the HR Department is notified.
          2.   A “COBRA Continuation Coverage Election Notice” is completed and mailed to the employee.
               A deletion form is completed and submitted to Fiserv. The employer’s copy is kept in the HR
               Department file.


                                             Health Insurance
                                               Page 1 of 2
                                                                                              Effective 03/10




E.   PAYMENT OF HEALTH CLAIMS

      1.    Medical and prescription claims are submitted to United Health Care for payment according
            to our “Certificate of Coverage” booklet. Under the fully insured plan, payment is made as
            claims are reviewed and approved.
      2.    Dental and vision claims are submitted to Fiserv Health. Claims are reviewed and prepared
            for payment. A weekly check register is faxed to the HR Department. After review, an
            “approval to Mail Warrants” notice is sent to the Warren County Auditor’s office. Following
            receipt of the signed “Approval”. The HR Department faxes the notice to Fiserv and the
            release/mail the authorized warrants.




APPROVED:


                                                                             March 26, 2010
      Megan K. Manuel, Superintendent                                            Date




                                         Health Insurance
                                           Page 2 of 2
                                                                                                     Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

INSERVICE TRAINING                                                                            SECTION 4.15



PURPOSE/GOAL:

      The Board intends to accurately and consistently document inservice training for all employees.

PROCEDURE:

1.    All staff are required to document any inservices they attend during the year on the approved
      inservice documentation log.

2.    A log sheet for each employee will be kept on file in a three ring notebook with the Division Secretary.

3.    Log sheets will be distributed to employees during agency and division inservices. Employees are
      required to update the log sheet and return it at the end of the inservice. Division Directors or the
      trainer will initial the log sheets as verification of attendance.

4.    Employees who attend inservices (conferences, workshops, college classes, etc.) presented by
      another agency are required to notify their Division Director and present proof of attendance, if
      necessary. The employee is responsible for obtaining his/her log sheet from the Division Secretary,
      updating the information, and having it initialed by the Division Director as verification of attendance.

5.    The Division Secretaries shall forward all inservice log sheets to the Administration Office each
      January. The Superintendent’s Secretary shall file all inservice log sheets in the employee’s
      personnel file.




APPROVED:


                                                                                   March 26, 2010
       Megan K. Manuel, Superintendent                                                 Date




                                             Inservice Training
                                                Page 1 of 1
                                                                                                     Effective 03/10




                     WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                    AGENCY PROCEDURE

PERSONNEL FILES                                                                               SECTION 4.16



PURPOSE:

To ensure that the personnel records are created and maintained in accordance with applicable state laws and
regulations.

PROCEDURE:

A.      CREATION

        Following the new employee’s completion of the New Hire Packet, but prior to the end of the
        employee’s initial pay period, the Superintendent’s Administrative Assistant/designee shall create a
        personnel file and a confidential file for the new employee.

B.      LOCATION

        An official personnel file for each employee will be maintained in the Business Services Department
        located at the Milo H. Banta Center.

C.      CONTENTS

        Personnel files will contain information relative to compensation, payroll deductions, evaluations, and
        such other information as may required including, but not limited to:

                1.       Application for employment
                2.       Name, permanent and current address, phone number
                3.       Emergency Notification information including name, address, home and work
                         phone numbers
                4.       Job Description
                5.       Employment Contracts
                6.       Certification/Registration records
                7.       License and Educational records
                8.       In-service log sheets
                9.       Personnel Action Forms, if necessary
                10.      Performance Evaluations
                11.      Corrective Action
                12.      Payroll Change Forms and Tax Forms

        Each employee will have a confidential personnel file, which will include all medical information
        (e.g. physical examinations, drug test results, etc.) as well as the results of the BCI/FBI
        background check.

        Employees must advise the Human Resources Administrative Assistant of any change in name,
        address, marital status, telephone number, number of withholding allowances claimed for tax
        purposes, citizenship or emergency contact information.

D.      INSPECTION

        Each employee has the right to a reasonable inspection of his or her own personnel file, upon written
        request. When a written request is received by the Human Resources Administrative Assistant, a


                                               Personnel Files
                                                Page 1 of 2
                                                                                               Effective 03/10




     convenient time for both parties will be scheduled for the review. Employees are permitted one
     complete copy of their personnel files at no charge. The usual fee of $.05 per page may be charged
     for additional copies. At no time may any material be removed by the employee from the personnel
     file.

E.   WRITTEN OBJECTIONS

     Employee may make written objections to any information contained in the file. Any written objection
     must be signed by the employee and will become part of the employee’s personnel file. Anonymous
     material or material from an unidentified source will not be placed in an employee’s file.

F.   MAINTENANCE

     Access, duplication, dissemination, and destruction of personnel records will comply with the Ohio
     Public Records Act (Ohio Rev. Code §149.43) and the Ohio Department of DD Rule 5123:2-1-02. All
     personnel files will be kept indefinitely.



APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                                           Personnel Files
                                            Page 2 of 2
                                                                                                Effective 03/10




               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

RECORDS MANAGEMENT                                                                        SECTION 4.17



PURPOSE:     To ensure that all employees maintain certain records in a similar manner.

PROCEDURE:

A.   UNION REPORTS

     1.      OAPSE

             The Fiscal Officers in the Warren County Auditor’s office shall send all reports of dues
             deductions to the OAPSE State Treasurer and the Local Treasurer with a list of those
             employees for whom payment has been made and the amount deducted within fifteen (15)
             days after each deduction is made.

             Monthly, the Fiscal Specialist shall furnish the OAPSE Union in Columbus a list of all
             personnel transactions, which involve additions/deletions from the OAPSE bargaining unit.

B.   FORM CHANGES

     Each time any current agency form is revised or a new form is added, it must be sent to the
     Superintendent for approval. Upon approval, the Administrative Secretary shall send a copy of the
     new or revised form to each policy manual holder with instructions to replace the old form or add the
     new form to the Personnel Policy Manual or to the Forms Book, whichever is applicable.

C.   POLICY MANUAL UPDATES

     Each time any section of the current Personnel Policy Manual (PPM) is amended, revised, added, or
     deleted the Superintendent Administrative Assistant shall update the master file for the PPM and send
     a copy of the new section to all applicable employees with instructions to replace the old policy
     section or add the new section to all of the Personnel Policy Manuals in her division. The new or
     revised policy will also be posted to the agency L drive.

D.   BOARD REPORTS

     All information and Board Reports from each Division to be included in the monthly Board packets
     must be received by the Superintendent Administrative Assistant by the first Friday of the month
     before the scheduled Board meeting.

E.   APPLICANT DATA RECORDS

     Applicant Data Records shall be initiated and maintained by the Superintendent Administrative
     Assistant. Upon receipt of an Applicant Data Record, the Superintendent or Human Resource
     Administrative Assistant shall record the information on the Affirmative Action Applicant Log.

F.   AFFIRMATIVE ACTION RECORDS

     By November 1st of each calendar year, the Human Resource Administrative Assistant shall receive
     the Affirmative Action Report (Form OCRC 54) from the Warren County Office of Management and
     Budget. This report should be received in June or July, completed and returned to the Warren County
     Office of Management and Budget. They will compile the information for Warren County and file it


                                        Records Management
                                            Page 1 of 2
                                                                                                       Effective 03/10




     with the Ohio Civil Rights Commission. Throughout the year, logs should be kept recording all
     applicants, new hires, promotions, demotions, and separations. The logs should indicate the race,
     sex, national origin, age (if available), disability status, and Vietnam veteran status for each individual.



APPROVED:


                                                                                    March 26, 2010
      Megan K. Manuel, Superintendent                                                   Date




                                           Records Management
                                               Page 2 of 2
                                                                                                    Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

TRANSFER, PROMOTION, DEMOTION                                                                SECTION 4.18



PURPOSE:        To record in an employee’s personnel file and notify the fiscal office when a current employee
has a change in his or her status, classification, and/or pay rate.

PROCEDURE:

A.      An employee may be transferred from one job to another within the same classification and salary at
        the discretion of the Superintendent. Transfers and assignments shall be made if such an action is in
        the best interest of the Agency and the individuals served. A request for transfer may be submitted by
        any employee or management.

B.      Following a recommendation to hire and approval from the Superintendent, a current employee who is
        transferred, promoted, or demoted must complete a Voluntary Classification Change Agreement Form
        to be filed in the personnel file with a copy given to the fiscal office.




APPROVED:


                                                                                   March 26, 2010
          Megan K. Manuel, Superintendent                                              Date




                                        Transfer, Promotion, Demotion
                                                  Page 1 of 1
                                                                                                    Effective 03/10




               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

WORKER’S COMPENSATION                                                                       SECTION 4.19



PURPOSE:     To comply with the State of Ohio Worker’s Compensation guidelines.

PROCEDURE:

A.   NOTIFICATION OF AN INJURY

     When an employee is injured on the job, he/she must notify their supervisor immediately. The
     supervisor must notify the Administrative Assistant in the Human Resources Division immediately.
     The employee will complete an Employee’s Report of Incident and Injury form and submit it to his/her
     supervisor within 24 hours of the injury.

     1.      Upon notification of an injury that will require medical treatment, the injured worker must
             obtain an “Injury Reporting Kit” from the Division director or designee. The Administrative
             Assistant must notify the Administrative Clerk in the Human Resources Division of the
             Warren County Office of Management and Budget of the injury.
     2.      If an injury does not require further medical attention, a copy of the Incident and Injury report
             will be forwarded to the Human Resources Division of the Warren County Office of
             Management and Budget after it has been signed by the Division Director and the
             Superintendent.
     3.      As the DD employees are under the Worker’s Compensation umbrella of Warren County, all
             Worker’s Compensation issues and questions are forwarded to the Office of Management
             and Budget after the initial notification.

B.   LOCATION

     A Worker’s Compensation file is maintained in the Business Services Department located at the Milo
     H. Banta Center.

C.   CONTENTS

     The Worker’s Compensation file contains copies of information received from the Bureau of Worker’s
     Compensation by the Office of Management and Budget.




APPROVED:


                                                                                  March 26, 2010
      Megan K. Manuel, Superintendent                                                 Date




                                        Worker’s Compensation
                                             Page 1 of 1
                                                                                                     Effective 03/10




               WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                              AGENCY PROCEDURE

CERTIFICATION FOR ODODD                                                                       SECTION 4.20



PURPOSE:     To provide uniform procedure for processing ODODD Certification paperwork.

PROCEDURE:

A.   NEW HIRE

     1.      Each employee shall provide appropriate documentation to obtain certification or proof of
             current certification/registration to the Administrative Office prior to employment. If
             certification is current upon hire a copy of this documentation will be retained for certification
             file and for Personnel file. The expiration date for this certification will be entered into agency
             database.

     2.      Each employee will complete and sign application for certification/registration prior to
             employment, if not currently certified. A check or money order for the appropriate amount will
             be attached to this application along with appropriate documentation. This will be obtained by
             the Administrative Office.

     3.      The Administrative Office will forward application, check or money order, documentation, and
             certification new hire form to Quality Assurance Director.
     4.      Quality Assurance Director will review documents to ensure proper completion and that all
             required documents are present for requested level of certification/registration.

     5.      Quality Assurance Director will photo copy application for staff certification file.

     6.      Quality Assurance Director will forward application with attached documentation to
             Superintendent for review and signature.

     7.      Upon return of signed application from the Superintendent, and attachments, the signed
             application will be copied for certification file. Application and attachments will be mailed to
             Ohio Department of DD, Division of Fiscal Administration.

     8.      Upon return of certificate and/or worksheet from ODODD, expiration date for
             certification/registration will be recorded in agency database. Certificate and worksheet will
             be copied for certification file. Documents will then be forwarded to employee with
             communication form explaining requirements for renewal, etc.

B.   RENEWAL

     1.      Each employee in a position requiring certification/registration is responsible for completing
             requirements of such certification/registration and forwarding appropriate documents,
             application, and check or money order to Quality Assurance Director prior to expiration of
             certificate. It is suggested that this is done at least 120 days in advance of expiration due to
             processing time at ODODD.

     2.      Director of Quality Assurance will track expiration dates of employee certification and will
             send reminders to employees 6 months in advance of expiration. This reminder will be
             copied for the appropriate Director and certification file.

     3.      Upon receipt of application, documentation, and check or money order, Quality Assurance

                                         Certification for ODODD
                                                Page 1 of 2
                                                                                                     Effective 03/10




            Director will review documents to ensure proper completion and that all required documents
            are present for requested level of certification/registration.

     4.     Quality Assurance Director will photo copy all materials for staff certification file.

     5.     Quality Assurance Director will forward application with attachments to Superintendent for
            review and signature.

     6.     Upon return of signed application from Superintendent, the signed application will be copied
            for certification file. Application and attachments will be mailed to ODODD, Division of Fiscal
            Administration. A certification/registration communication form will be sent to employee
            seeking certification to verify paperwork was sent, and will be copied to appropriate Director,
            and a copy will be retained for certification file. (The date that the application is mailed will be
            recorded.)

     7.     Upon return of certificate and/or worksheet from ODODD, expiration date for
            certification/registration will be recorded in agency database. Certificate and worksheet will
            be copied for certification file. Documents will then be forwarded to employee with
            communication form explaining requirements for renewal, etc. This will be copied for
            appropriate Director and certification file as well.



APPROVED:


                                                                                   March 26, 2010
      Megan K. Manuel, Superintendent                                                  Date




                                        Certification for ODODD
                                               Page 2 of 2
                                                                                                 Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

LEGAL ASSISTANCE FOR PERSONNEL                                                            SECTION 4.21



PROCEDURE:

Warren County Board of DD is free to assist its personnel when actions of the organization are being put
under scrutiny. In accordance with O.R.C. 309.09, the County Prosecutor is the legal representative of the
Board. The Warren County Prosecutor’s Office may provide legal assistance to the employees of the Board
regarding actions pertaining to the Board.


APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                      Legal Assistance for Personnel
                                               Page 1 of 1
                                                                                   Effective 03/10




            WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                           AGENCY PROCEDURE

JOB DESCRIPTIONS                                                            SECTION 4.22


PROCEDURE:

A.   A job description will be created for each employee position at the Warren County Board
     of DD.

B.   When changes in the job duties of a position occur, the division director or supervisor
     must notify the Human Resources Director. The Human Resources Director will ensure
     that the changes are made to the job description.

C.   When changes are made to a job description, the employee will sign the updated job
     description.

D.   Each employee will sign a new job description annually at the same time that the
     supervisor reviews the employee’s evaluation.


APPROVED:


                                                                     March 26, 2010
      Megan K. Manuel, Superintendent                                    Date




                                     Job Descriptions
                                       Page 1 of 1
                                                                                                     Effective 01/08




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

PRIOR SERVICE CREDIT                                                                          SECTION 4.23


PURPOSE:       To establish guidelines for the awarding of prior service credit when assigning pay rates
for employees.

PROCEDURE:

A.     EXTERNAL APPLICANTS:

        1.      New hires for positions that require a professional license or certificate such as, but not
                limited to, occupational therapists, physical therapists, speech therapists, and nurses
                may be given credit for up to ten (10) years experience. The experience must have been
                relevant to their new position and required a license to perform.

        2.      All MR/DD certificated positions such as, but not limited to, adult service providers, adult
                service administrators, vehicle operators, and bus assistants may receive up to ten (10)
                years experience credit for the same or similar work. If union agreements are in effect,
                all placement decisions must concur with the contract.

        3.      Non-licensed or certificated positions such as, but not limited to, clerical staff, business
                office or personnel staff, custodial staff and maintenance staff may receive up to ten (10)
                years experience credit for the same or similar experience.

        4.      The director of the hiring division will recommend to the Superintendent or his/her
                designee the amount of experience that he/she is recommending the applicant to receive.
                The Human Resources Director will review the recommendation. The Superintendent or
                designee will have final approval.

        5.      All prior service, for which an applicant is receiving credit, must be documented and
                verified in writing by the applicant’s former employer(s). It is the applicant’s responsibility
                to obtain this documentation from the former employer(s).

B.      INTERNAL APPLICANTS:

       1.      Staff making lateral moves will move to the same step on the new position salary
               schedule, as he/she is currently on. Whether a move is lateral or not will be determined
               by the Human Resources Director and approved by the Superintendent or his/her
               designee. Such a determination should occur and be communicated to the staff person
               prior to a move being finalized.

        2.      Staff who move from one classification to another that has a lower salary schedule will be
                placed on their new schedule at the same step as they are currently on.

        3.      Staff who are promoted will be placed on their new schedule at a point that ensures an
                appropriate increase in salary. The Human Resource Director will determine what step
                the employee will be placed on.




                                             Prior Service Credit
                                                 Page 1 of 2
                                                                                              Effective 01/08




C.     DETERMINING PRIOR SERVICE CREDIT:

       1.     If an employee has worked a combination of varying status, (FT, PT, FTS, PTS) the
              credit for experience shall be prorated based on the actual hours worked by the
              employee and the one year equivalent of the new position, not to exceed the actual
              number of calendar years that the employee has been employed. Substitute time does
              not count as prior service credit.

       2.     In extreme circumstances, such as difficult to fill positions, the Superintendent reserves
              the right to circumvent the salary schedule or approve if doing so is necessary to attract
              qualified applicants.

       3.     A negotiated union contract takes precedence over the above stated procedure.

D.     EARLY INTERVENTION SPECIALISTS:

       1.     Early Intervention Specialist employed prior to April 17, 2007 who leave employment with
              the Board and come back to work for the Board after April 16, 2007 will be placed on the
              salary schedule that was adopted for all EI Specialists hired after April 16, 2007. They
              will not be placed on the same salary schedule they were on before they left.


APPROVED:



                                                                           January 11, 2008
     Michael C. Virelli II, Superintendent                                      Date




                                         Prior Service Credit
                                             Page 2 of 2
                                                                                                 Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

STAFF TRAINING                                                                           SECTION 4.24


PURPOSE:       To establish guidelines for the initial and annual training of Board Employees.

PROCEDURE:

All division directors will ensure each employee completes their required training as indicated on the
attached training list.

A.     INITIAL STAFF TRAINING:

       1. New employees will complete their initial training on the on-line Public School Works program
          within five working days of hire.
       2. New employees will complete agency orientation within 90 days of hire.

B.     ANNUAL STAFF TRAINING:

       1. All staff shall complete their annual training on the on-line Public School Works program
          between the dates of July 1 and August 31 of each year unless otherwise assigned by
          division director (see attached training list).
       2. Each division shall be responsible for the scheduling the completion of the annual staff
          training on Public School Works program.
       3. In order to receive ODODD CEU’s, staff members must submit training transcript to Quality
                                                 TH
          Assurance Division by September 15 of each year.



APPROVED:


                                                                                March 26, 2010
         Megan K. Manuel, Superintendent                                            Date




                                              Staff Training
                                               Page 1 of 1
                                                                                                Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

ALCOHOL AND DRUG FREE WORKPLACE                                                         SECTION 4.25


PURPOSE:       To establish guidelines for the development of an alcohol and drug free workplace.

PROCEDURE:

A. DRUG TESTING PROCEDURES:

   1. Testing shall be done by a facility that is certified under National Institute Drug Abuse (NIDA)
      standards and shall consist of tests that detect the presence of the following: amphetamines,
      Cannabinoids, Cocaine, PCP, and Opiates.

   2. A split sample specimen shall be collected at a health care facility designated by the Board of DD.

   3. The Board of DD will request urine samples in testing for controlled substances that will be
      collected at the health care facility and sent to the NIDA-certified laboratory specified by the
      County.

   4. Employees required to be tested will be given a written copy of the procedures to be followed for
      collection of the sample.

   5. In the event an adequate sample cannot be produced, the employee may be asked to drink fluids
      to induce urination.

   6. The employee shall not be observed when the urine specimen is given unless there is a reason to
      believe that the employee may alter or substitute the specimen to be provided. Stringent
      alteration and/or substitution procedures will be followed by the sample collection site staff.

   7. Sample collection specimen containers shall be sealed containers prior to use. After collection,
      the specimen shall be sealed with evidence tape and labeled in the presence of the employee.

B. NEGATIVE RESULTS:

   1. Tests that are below the levels considered to be positive shall be determined as negative.
      Records concerning negative tests shall not be maintained in an employee’s personnel file.

C. POSITIVE RESULTS:

   1. The employee shall be given notice of the results by the Medical Review Officer (MRO) and given
      the opportunity to explain any legitimate use for the controlled substance.

   2. Upon written request and at the employee’s expense, the employee may have the split sample,
      which was taken at the time of collection, retested by the same laboratory or at another NIDA-
      certified laboratory chosen by the employee, provided such request is presented within 72 hours
      of notification of the result.
   3. Following the completion of all tests, and discussion of the positive result with the employee, the
      MRO will notify the County of the positive result in a confidential manner established by the MRO
      and the County. The County will then notify the Board of DD in a confidential manner

   4. The Board of DD will refer all employees testing positive for controlled substances to counseling
      and rehabilitation. The Board of DD may also discipline the employee, up to and including


                                    Alcohol and Drug Free Workplace
                                               Page 1 of 3
                                                                                                 Effective 03/10




       termination, after consideration of all tests presented. A second positive drug test by the
       employee shall result in disciplinary action up to and including termination. Probationary
       employees may be discharged for any violation of this drug and alcohol procedure or the Alcohol
       and Drug Free Workplace Policy and need not be offered rehabilitation.

D. ALCOHOL TESTING PROCEDURES:

   1. Testing for alcohol concentration shall consist of a Breathalyzer test administered by a trained
      Breath Alcohol Technician (BAT) or a certified law enforcement officer at the Warren County
      Sheriff’s Office.

   2. Only evidentiary breath testing (EBT) devices listed on the National Highway Traffic Safety
      Administration’s (NHTSA) Conforming Products List (CPL) shall be used.

   3. A test of .039 blood alcohol level or above is considered to be impairment in all cases. The
      impairment of employees registering below .039 is to be determined by an analysis of all relevant
      factors (e.g., blood alcohol level, time of day, physical signs displayed by the employee, what the
      employee is required to do on the job, etc.)

   4. Records of test results will not be kept in the employee’s personnel file.

E. TEST RESULTS:

   1. All test results shall be treated as confidential to the extent allowed by law. All test results must
      be retained in a secure file separate and apart from the employee’s personnel file.

   2. In case of a positive drug test, results will be disclosed to the employee, employee’s supervisor
      and/or division director, and only those additional people with a specific need to know because of
      subsequent rehabilitation and/or disciplinary action which may be taken.

F. TRANSPORTATION:

   1. In the case of pre-employment testing, the employee shall be instructed to report to the collection
      site for testing.

   2. In the case of reasonable suspicion testing, the employee shall be transported to the alcohol
      and/or drug-testing site by the employee’s supervisor, another management employee of the
      Board of DD, or designee.

   3. In the case of reasonable suspicion drug testing, following a urine sample collection, the
      employee shall be transported home by a management employee of the Board of DD, or
      designee.
   4. Following an alcohol Breathalyzer test, depending on the determination of impairment, the
      employee should be returned to work or transported home.

G. PAY STATUS:

   1. The employee remains on a paid status until his arrival at home. The employee shall be relieved
      of duty without pay from the time of arrival home until he/she is permitted to return to work.

   2. For drug testing, the employee will remain at home without pay until the drug test results have
      been received by the Board of DD. For a positive alcohol test, the employee will remain at home
      for at least the remainder of the workday. The Board of DD reserves the right to determine when
      it is safe to have the employee return and what, if any, paid leave time may be used.




                                     Alcohol and Drug Free Workplace
                                                Page 2 of 3
                                                                                           Effective 03/10




   3. If the drug tests are negative, the employee shall be compensated for the period of leave of
      absence without pay unless other work rule violations are proven to have occurred.

H. TIME LIMITATIONS:

   1. Referral for alcohol and/or drug testing should normally occur within two (2) hours of the
      supervisor’s observation. In no case will more than four (4) hours elapse from the time of
      observation to the time of sample collection.




APPROVED:


                                                                          March 26, 2010
        Megan K. Manuel, Superintendent                                       Date




                                  Alcohol and Drug Free Workplace
                                             Page 3 of 3
                                                                                                Effective 03/10




                 WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                AGENCY PROCEDURE

APPLICANT RECRUITMENT                                                                     SECTION 4.26


PURPOSE: The purpose of this procedure is to ensure that the Board complies with all applicable state
and local employment laws related to applicant recruitment; to attempt to recruit the best qualified
candidates for each vacancy; and to attempt to recruit a diverse workforce.

PROCEDURE:

A. POSTINGS

   1. When the Superintendent determines that a vacancy for an existing position exists, the following
      procedure shall be followed:

       a. Create a Notice of Job Posting for the position. Each Notice, insofar as practicable, shall
          specify the title, nature of the job, the required qualifications, the shift, the status, (e. g.
          classified, management contract, union, etc), the method for applying, and the deadline for
          submitting applications. Most positions require a minimal posting period of ten (10) calendar
          days.
       b. Send/fax/e-mail copies of the Posting to the Division Secretary in each building and each
          Division and to the Warren County One Stop.
       c. Post the Notice and Job Description on the bulletin board in the Administration Building.
       d. Create a job file for the posted position, including an application log form.
       e. After the 10-day posting period has passed, forward all application to the supervisor who will
          be conducting initial interviews.

   2. When the Superintendent determines that a new position is needed, prior to posting the position
      as required above, the Board must approve the creation of the new position. The Human
      Resources Director will prepare a Board Resolution outlining the position title, pay range, job
      description and the justification for the new position and include the resolution in the next Board
      packet. Following approval by the Board, follow the procedures outlined above.

B. ADVERTISEMENTS

   1. When the Division Director requests that an ad be placed and upon approval from the
      Superintendent, the Division Director shall contact the Superintendent Administrative Assistant
      and he/she shall prepare a Purchase Order for the ad. A separate P.O. must be prepared for
      each newspaper that will carry the ad. The Division Director shall also submit to the
      Superintendent Administrative Assistant the information to be used for the ad including the
      recommended language for the ad and date (s) that the ad should run. The Superintendent’s
      Administrative Assistant will telephone the named contact person at each newspaper and fax the
      ad wording to the newspaper. When the newspaper notifies the Superintendent’s Administrative
      Assistant of the exact cost of the ad, the P.O. will be completed and submitted for approval.

C. APPLICATIONS

   1. INTERNAL

       a. During the ten (10) day posting period, any current employee wishing to apply for the vacant
          position shall complete and submit an Internal Application Form. Any current OAPSE
          bargaining unit employee who timely applies for a different OAPSE covered position shall be



                                          Applicant Recruitment
                                               Page 1 of 2
                                                                                             Effective 03/10




          interviewed if that employee appears to meet all of the posted qualifications for the vacant
          position.

  2. EXTERNAL

     a. All outside applicants, including those who submit a resume, shall be required to complete an
        agency Application Form at the Warren County One Stop prior to the deadline for the posting
        period to be considered for any vacant position.

     b. Applications and resumes for positions will be accepted at any time. Upon receipt, they shall
        be date stamped and filed in a general application file or in the appropriated file for the
        relevant classification.

     c.   Applications and resumes will be maintained in the general file for one (1) year. Any
          application or resume which does not relate to a specific posted position during the on (1)
          year period may be removed and placed in storage.




APPROVED:


                                                                            March 26, 2010
      Megan K. Manuel, Superintendent                                           Date




                                        Applicant Recruitment
                                             Page 2 of 2
                                                                                                      Effective 03/10




                  WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                 AGENCY PROCEDURE

APPLICANT SELECTION                                                                            SECTION 4.27



PURPOSE: To ensure compliance with all applicable employment laws and regulations related to applicant
selection and to attempt to select the best-qualified candidate for each vacancy.

PROCEDURE:

A. WHO SHOULD BE INTERVIEWED

   1. The Board’s desire is to hire the most qualified applicant for each position, whether that person is an
      internal or external applicant. Generally, the top three (3) to five (5) candidates should be interviewed.
       If, however, the vacancy is an OAPSE bargaining unit position, all current OAPSE bargaining unit
      employees who applied must be interviewed if the employee appears to meet the qualifications listed
      on the posting.

B. THE INTERVIEW PROCESS

   1. For each posted vacancy, the questions and the person(s) conducting the interviews must be the
      same for each candidate. The Division Director may develop a standard interview sheet for each
      position in his or her division. The Division Director shall designate the person(s) to do the interview.
      The person conducting the interview shall provide the applicant with a copy of the current position
      description.

   2. At the completion of each interview, each person participating in the interview shall record a brief
      evaluation of each candidate.

   3. When all of the interviews are completed, the person(s) shall designate his or her choices in order of
      priority and report this to the Division Director.

   4. If the vacant position is in the OAPSE bargaining unit, in the event that more than one OAPSE
      employees are tied for the best qualified candidate, then the employee with the most seniority shall be
      offered the position.

C. POST INTERVIEW/PRE-OFFER PROCEDURES

   1. Telephone Reference Check: The Division Director or the supervisor conducting the interviews shall
      call at least three (3) references to seek information regarding the applicant’s work habits, knowledge,
      skills, and abilities. At least two (2) of the references must be professional references. The other
      reference may be a personal reference. The information should be documented on the “Telephone
      Reference Check Form.”

   2. Division Director Recommendation : Following the completion of the interview process and
      reference checks, the Division Director shall complete a Recommendation for Hire form and submit
      the form along with all information received on the applicant to the Administrative Assistant -
      Superintendent, who will check the Abuse Registry and Ohio Nurses’ Aide Registry.

   3. Superintendent’s Approval: Before an applicant may be offered a position, the Superintendent must
      approve the offer of employment by signing the Recommendation for Hire form. Once the
      Superintendent has approved the offer, the Chief Financial Officer/Human Resource Director shall
      assign the rate of pay. The Administrative Assistant - Superintendent shall then contact the applicant
      to make an appointment to complete the HR Profile Form, sign necessary consent forms, and


                                              Applicant Selection
                                                 Page 1 of 2
                                                                                               Effective 03/10




     complete the certification/registration form.

     4. HR Profile: After an applicant has been recommended for hire, the applicant shall be required to
        complete and sign the HR Profile form and submit the form to the Administrative Assistant -
        Superintendent. The Administrative Assistant - Superintendent shall complete the bottom portion
        of the form and fax the form for a conviction history check and a motor vehicle record check. An
        applicant cannot be offered employment with the Board until satisfactory results, which usually
        takes only 3-4 days are received.

     5. Drug Test: All new hires must pass a pre-employment drug test as a condition to being hired.
        Employees applying for positions requiring a CDL must pass a mandatory DOT drug screen as
        well. Prior to being hired, the applicant shall go to Bethesda Arrow Springs to provide a urine
        sample for the drug screen. An applicant may not begin work until a negative drug screen result
        is received from Bethesda Arrow Springs.




APPROVED:


                                                                              March 26, 2010
      Megan K. Manuel, Superintendent                                             Date




                                           Applicant Selection
                                              Page 2 of 2
                                                                                                       Effective 03/10




                    WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                   AGENCY PROCEDURE

APPLICANT HIRING                                                                                SECTION 4.28



PURPOSE:         The Board intends to comply with all relevant state and federal employment laws related to
the hiring of new employees.

PROCEDURE:

A. POST-OFFER PROCEDURES

    1. Following approval by the Superintendent and receipt of a favorable HR Profile and a negative drug
       screen, the Superintendent’s Administrative Assistant shall contact the applicant and request that he
       or she come in to complete the New Hire Packet.

    2. During the appointment, the Superintendent’s Administrative Assistant shall confirm the applicant’s
       start date and obtain the applicant’s employee number for the fiscal office.

    3. Prior to the first day of employment, all full-time, full-time seasonal, part-time, and part-time seasonal
       employees shall complete a new hire packet including the following:

        a.   BCI/FBI Background Check Affidavit and Fingerprint Cards
        b.   Deferred Compensation Plan Pamphlet
        c.   EAP Pamphlet
        d.   Declaration Form
        e.   Credit Union Pamphlet
        f.   Application for Certification or Registration
        g.   New Employee Acknowledgement Form
        h.   Hepatitis B Consent or Waiver Form
        i.   Emergency Notification Form
        j.   I-9 Form (Verification of Citizenship)
        k.   New Hire Report
        l.   Form Not Covered by Social Security
        m.   Prior Service Verification for Sick/Vacation
        n.   PERS/STRS Form
        o.   W-4, State and Local Tax Forms, School District Form
        p.   Health Care Enrollment Information
        q.   Life Insurance Form
        r.   Payroll Deduction Form
        s.   Position Description (2 copies)
        t.   Proof of Fitness for Duty Physical and TB Test

        Prior to employment, all new substitute employees shall be required to complete the following forms:

             a.   BCI/FBI Background Check Affidavit and Fingerprint Cards
             b.   EAP Pamphlet
             c.   Declaration Form
             d.   Application for Certification or Registration
                  e. New Employee Acknowledgement Form
                  f. Hepatitis B Consent or Waiver Form
                  g. Emergency Notification Form
                  h. I-9 Form (Verification of Citizenship)
                  i. New Hire Report


                                                Applicant Hiring
                                                 Page 1 of 2
                                                                                                   Effective 03/10




                j.   Prior Service Verification for Sick/Vacation
                k.   PERS/STRS Form
                l.   Form Not Covered by Social Security
                m.   W-4, State and Local Tax Forms, School District Form
                n.   Position Description (2 copies)
                o.   Proof of Fitness for Duty Physical and TB Test

4. Prior to the end of the new employee’s initial pay period, the HR Administrative Assistant shall input all
   necessary data in the personnel database.

5. Send Reject Letters- Each applicant for the position whether interviewed or not shall receive a letter
   announcing the filling of the vacancy. Candidates not selected are to be informed that we have selected
   the candidate judged to be the best match. It is not necessary to explain why a particular applicant was
   not selected. The Division Secretary shall prepare a form letter for the Division Director’s signature for
   each individual who was interviewed for the position, and place copies of each letter in the posting file.

6. Closing the Posting File- The Superintendent’s Administrative Assistant shall complete the application and
   interview logs to indicate who was selected for the position, place copies of all reject letters and offer
   letters in the file and close the file by placing it in the postings file drawer. The posting file must be
   maintained for at least six (6) years.



APPROVED:


                                                                                  March 26, 2010
          Megan K. Manuel, Superintendent                                             Date




                                               Applicant Hiring
                                                Page 2 of 2
                                                                                                       Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

CRIMINAL BACKGROUND CHECK (BCI/FBI)                                                             SECTION 4.29



PURPOSE:        To comply with the state laws and regulations requiring criminal background investigation
checks on all new hires.

PROCEDURE:

A.   Following an offer of employment, but prior to a new employee’s first day of work, an applicant shall be
     required to submit to a Bureau of Criminal Investigation (BCI) and/or Federal Bureau of Investigation
     (FBI) background check.

B.   A new employee must sign a form at the time of the offer of employment that continued employment is
     contingent upon favorable results of the BCI/FBI investigation.

C.   The new employee must complete the “WebCheck Application “ and take the form to the Warren County
     Sheriff’s Office located at 550 Justice Drive in Lebanon to be fingerprinted.

D.   When the results of the BCI/FBI check are received, any adverse information must be reported to the
     Human Resources Director.

E.   All BCI/FBI results are to be filed in the employee’s confidential file, rather than in the public personnel
      file.

F.   The Warren County Sheriff’s Office will bill the WCBDD monthly by sending an invoice. When paying the
     invoice, the check must indicate the Warren County Sheriff’s Office Customer Number (#7JT416) and a
     copy of the invoice should be returned with the check.




APPROVED:


                                                                                     March 26, 2010
          Megan K. Manuel, Superintendent                                                Date




                                     Criminal Background Check (BCI/FBI)
                                                 Page 1 of 1
                                                                                                     Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMPLOYEE PERFORMANCE EVALUATIONS                                                              SECTION 4.30



PURPOSE:        To provide a mechanism for supervisors to evaluate an employee’s job performance; to work
toward attainment of agency mission, goals, and objectives; inform the employees of strengths, weaknesses,
and progress; improve performance and productivity; strengthen work relations and improve communication;
develop employee skills; and recognize accomplishments and good work.

PROCEDURE:

A. TYPES

     1. Probationary

        Newly hired or promoted employees serving a probationary period shall be evaluated using the
        evaluation form for their position twice during their probation: once at the midpoint and once at least
        ten (10) days prior to the expiration of the probationary period.

     2. Annual

        All employees shall be evaluated annually during the month of their appointment anniversary date.

     3. Special

        When necessary due to performance deficiencies, employees may be evaluated at times other than
        during the probationary period or on their anniversary. For example, if an employee has a poor
        annual evaluation, the supervisor (with the permission of the Division Director) may require another
        evaluation in 30, 60, or 90 days to see if the employee’s performance is improving.

B.   EVALUATION PROCESS

        1. The Supervisor will forward the Employee Input page of the evaluation and ask the employee to
           complete it at least one week prior to the evaluation date. Using the employee’s input and the
           supervisor’s own observations, the employee’s supervisor should complete the Performance
           Evaluation Form, including the Evaluator’s Comments and signature.

        2. The Evaluator shall forward the completed evaluation to his or her supervisor for review. The
           rater’s supervisor (Reviewer) shall sign and date the last page of the evaluation noting that it was
           reviewed.

        3. The Reviewer shall forward the evaluation to the Human Resources Director for review and
           initialing. The Human Resource Director will then forward the evaluation to the Superintendent for
           review and initialing. The signed and reviewed form is returned to the original Evaluator.

        4. The Evaluator will meet with the employee to discuss the evaluation. If necessary, they will
           develop a performance improvement plan. The employee should sign the evaluation and be given
           a copy. The original should be sent to the Administrative Assistant in HR to be logged in and filed
           in the employee’s personnel file.

        5. Throughout the year, the supervisor should periodically record observations of employees. Those
           observations may include positive comments, concerns, and track progress on the performance
           improvements.


                                      Employee Performance Evaluation
                                                Page 1 of 2
                                                                                 Effective 03/10




APPROVED:


                                                                March 26, 2010
      Megan K. Manuel, Superintendent                               Date




                              Employee Performance Evaluation
                                        Page 2 of 2
                                                                                                      Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMPLOYEE SEPARATION                                                                            SECTION 4.31



PURPOSE:       To ensure compliance with all state and federal employment laws and regulations related to
an employee’s separation from employment.

PROCEDURE:

A. RESIGNATION

    All original letters of resignation must be sent to the Superintendent immediately upon receipt. The
    Superintendent Administrative Assistant shall send a Resignation Acceptance Letter to the employee and
    file the letter of resignation until the effective date. During the pay period in which the resignation is
    effective, the Administrative Assistant in HR shall update the personnel database and print the County
    Maintenance Form. Upon completion of the payroll information, the original letter of resignation shall be
    filed in the employee’s personnel file. Based on the position held, the employee is required to give proper
    notice as described in the WCBDD Personnel Policy Manual Resignation Policy.

    An employee who resigns is entitled to be paid for his or her accumulated vacation leave, up to the
    maximum allowed. The employee is not entitled to cash out unused sick leave balances or personal leave
    balances.

B. RETIREMENT

    Employees who are eligible for retirement under OPERS or STRS for age and/or service shall be provided
    information on the retirement procedure and given the phone number for the appropriate retirement
    system. When the application is received, the HR Administrative Assistant shall complete the Employer’s
    Information Section and send the application to the Superintendent for review and signature. A copy of the
    application shall be kept in the employee’s confidential file.

    An employee who is seeking disability retirement may be entitled to FMLA and/or extended illness leave
    while awaiting the eligibility determination by the retirement system. The Superintendent must approve all
    leave requests. When the application is received, the HR Administrative Assistant shall complete the
    Employer’s Information Section and send the application to the Superintendent for review and signature.
    A copy of the application shall be kept in the employee’s confidential file.

    Employees who retire under a state retirement system may be entitled to a payout of accumulated sick
    leave and vacation leave (see below).

C. TERMINATION FOR CAUSE

    Only the Superintendent can terminate an employee for cause. The employee must be afforded all due
    process procedures outlined in the Personnel Policy Manual and/or the applicable labor agreement. Prior
    to or at the time the employee is given the notice of termination, the employee shall be required to turn in
    all WCBDD property, including but not limited to all keys, phones, pagers, phone cards, laptops,
    identification cards, etc. The notice of termination shall be filed in the employee’s personnel file. The
    Board must follow all applicable laws for termination.

    An employee who is terminated for cause is entitled to be paid for his or her accumulated vacation leave
    and compensatory time, up to the maximum allowed. The employee is not entitled to cash out unused
    sick leave balances or personal leave balances.



                                             Employee Separation
                                                 Page 1 of 2
                                                                                                      Effective 03/10




D. VACATION PAYOUT

   Upon separation from employment with the WCBDD, the employee shall be paid for any accumulated but
   unused vacation leave up to the maximum allowed on the next regular payday following the employee’s
   last regular paycheck for hours worked. Any remaining balance over and above the maximum accrual
   allowed shall be eliminated.

E. SICK LEAVE PAYOUT

   Employees are only entitled to receive cash payments for accrued but unused sick leave if the employee
   retires under a state retirement plan such as PERS or STRS, and if the employee has ten (10) or more
   years of service with a public agency.

   If the employee qualifies for a cash payout, the rate shall be based upon the employee’s rate of pay at the
   time of retirement and be shall be limited according to the following:

   1. A qualified employee, who had been continuously employed by Warren County since April 2, 1985, or
      before, is eligible to be paid in cash for one hundred percent (100%) of his/her accrued but unused
      sick leave, up to a maximum payment of one hundred twenty (120) days.

   2. A qualified employee who was hired after April 2, 1985 is eligible to be paid in cash for one-fourth
      (1/4) of the value of his/her accrued but unused sick leave, up to a maximum payment of thirty (30)
      days.

   Employees are permitted to cash out sick leave only once, therefore, following each sick leave payout;
   any remaining sick leave balance for that employee shall be eliminated from the books.

F. COMPENSATORY TIME

   Employees who are separated for any reason are entitled to be paid for any accumulated but unused
   compensatory time, up to the maximum allowed accumulation. The employee shall be paid at his or her
   current rate of pay.

G. EXIT INTERVIEW

   Supervisors and/or Division Directors shall request a meeting with employees who resign or retire to
   gather information and feedback from the employee regarding the employee’s reason for leaving the
   agency and any suggestions the employee may have for improving the work environment. The employee
   should complete an exit interview form during the meeting.

H. PROPERTY RETURN

   An employee’s final paycheck shall not be issued until all Board property, including but not limited to keys,
   gas card, cell phone, laptop, original documents, etc., are returned to the employee’s immediate
   supervisor.


APPROVED:


                                                                                    March 26, 2010
         Megan K. Manuel, Superintendent                                                Date




                                            Employee Separation
                                                Page 2 of 2
                                                                                                   Effective 03/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMPLOYEE OF THE MONTH                                                                      SECTION 4.32


Purpose/Goal: The Warren County Board of Developmental Disabilities wishes to recognize staff members
who have exhibited superior work in the duties outlined in their job descriptions and/or who have exhibited
significant effort when working with the individuals/families enrolled in the agency programs.
Procedure:

    1. Any employee can be nominated by any co-worker or supervisor for exceptional work within any
       month. The only exception is that no employee on a management contract will be eligible for the
       award.

    2. The Employee of the Month Nomination form will be completed by the person recommending the
       employee and must be filled out entirely.

    3. The Employee of the Month Nomination form must be received by the Human Resources Department
       by the 7th of the following month.

    4. A committee will be established by the Superintendent to review each nomination. The committee will
       be created with staff from all divisions.

    5. The committee will be comprised of staff that is not eligible for the award.

    6. Each awarded Employee of the Month will receive a personal day equal to his/her regularly scheduled
       hours per day.

    The Employee of the Month will be named by the 14th of the following month

APPROVED:


                                                                                  March 26, 2010
         Megan K. Manuel, Superintendent                                              Date




                                           Employee of the Month
                                                Page 1 of 1
                                                                                                      Effective 05/10




                   WARREN COUNTY BOARD OF DEVELOPMENTAL DISABILITES
                                  AGENCY PROCEDURE

EMERGENCY MEDICAL INFORMATION – EMPLOYEE                                                       SECTION 4.33



Purpose: To establish and maintain a current list of employees on a Division by Division basis for the
purpose of having Emergency Medical information readily available when needed.

Procedure: Each Division shall keep a binder containing the current (1 year old or less) Emergency Medical
information for each employee that works for that Division. The binder shall be maintained by the Secretary of
the Division and updated monthly. To maintain confidentiality, the binder shall always be kept in a locked
storage with access limited to the Division Director, the Division Secretary, and at least one other division
employee.

During emergency drills the Division Secretary or designee shall bring the Emergency Medical binders for
employees and participants when they leave.

In the event the Emergency Medical information is not available during an emergency; a call shall be made to
the Human Resources Administrative Assistant to retrieve the required information from the personnel files.

Employees with critical needs are encouraged to make additional provisions for communicating those needs in
the event they become incapacitated, such as med-alert bracelets, emergency instructions in their billfold, etc.
 Employees are responsible for updating their emergency medical information as their personal situation
changes.

APPROVED:


                                                                                      May 11, 2010
          Megan K. Manuel, Superintendent                                                Date




                                  Emergency Medical Information – Employee
                                               Page 1 of 1

				
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